Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Subtotal or Total Hysterectomy after Cesarean Delivery
Also known as: Hysterectomy following C-section, Cesarean hysterectomy
Summary
A hysterectomy after a cesarean delivery involves the surgical removal of the uterus (either partially or completely) immediately following the delivery of a baby via C-section.
Purpose
Medical Condition
This procedure addresses conditions that may make it necessary to remove the uterus immediately after delivery, such as severe postpartum hemorrhage, uterine rupture, or placental abnormalities.
Goals
The primary goal is to save the mother's life or to address serious medical conditions that threaten her health.
Indications
- Uncontrolled postpartum hemorrhage
- Uterine atony (failure of the uterus to contract)
- Placental abnormalities (e.g., placenta previa, placenta accreta)
- Uterine rupture
- Severe infection
Patient Criteria
- Patients who experience significant complications during a C-section that cannot be managed through other interventions.
Preparation
Pre-procedure Instructions
- Fasting for at least 8 hours before surgery.
- Medication adjustments as advised by the healthcare provider.
- Baseline diagnostic tests including blood counts, coagulation profiles, and imaging studies if needed.
Procedure Description
- The C-section is performed to deliver the baby.
- After the baby is safely delivered, attention is focused on the uterus.
- Depending on the underlying condition, a subtotal (removing the upper part of the uterus) or total hysterectomy (removing the entire uterus) is performed.
- The surgical field is thoroughly cleaned and checked for any bleeding sites.
- The incision is closed in layers to ensure proper healing.
Tools and Equipment
- Surgical instruments such as scalpels, clamps, and sutures.
- Hemostatic agents to control bleeding.
- Anesthesia equipment.
Anesthesia
General anesthesia is administered to ensure the mother is asleep and pain-free during the procedure.
Duration
The procedure can take between 2 to 4 hours, depending on complexity and patient condition.
Setting
- Typically performed in a hospital operating room.
Personnel
- Lead surgeon (often an obstetrician-gynecologist)
- Surgical assistants
- Scrub nurses
- Anesthesiologist
- Circulating nurses
Risks and Complications
Common Risks
- Infection
- Blood loss and need for transfusion
- Blood clots
- Injury to surrounding organs (bladder, intestines)
Rare Risks
- Anesthesia complications
- Severe bleeding requiring further surgery
- Rare but serious infections
Benefits
- Immediate resolution of life-threatening conditions.
- Prevents further complications associated with the uterus after delivery.
- Often results in stabilization and rapid improvement of the mother's health.
Recovery
Post-procedure Care
- Pain management with medications.
- Monitoring for signs of infection or complications.
- Instructions on activity restrictions and care for the surgical site.
Recovery Time
- Hospital stay of 3-5 days post-surgery.
- Full recovery may take up to 6-8 weeks.
Alternatives
Other treatments may include:
- Medication and non-surgical management of bleeding or infection.
Pros and Cons
- High success rates in emergency situations for hysterectomy.
- Non-surgical treatments might not be effective in severe cases but pose fewer surgical risks.
Patient Experience
During the Procedure
- The patient will be under general anesthesia and will not feel any pain or remember the procedure.
After the Procedure
- Expect soreness and mild-to-moderate pain managed with medications.
- Gradual return to normal activities over several weeks, with possible long-term impact on hormonal balance and menstrual cycle.
Pain management techniques and comfort measures will be provided to ensure a smooth recovery period.