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Treatment of incomplete abortion, any trimester, completed surgically
CPT4 code
Name of the Procedure:
Dilation and Curettage (D&C) for Treatment of Incomplete Abortion
Common Terms: D&C, Surgical Completion of Miscarriage
Summary
A Dilation and Curettage (D&C) procedure is a surgical method used to clear the uterus of any remaining tissue following an incomplete abortion, where some pregnancy tissues remain in the uterus after a miscarriage.
Purpose
The D&C procedure addresses incomplete abortion, where not all pregnancy tissue is naturally expelled from the uterus.
Goals: Remove residual tissue to prevent infection, heavy bleeding, or other complications.
Indications
- Persistent bleeding after a miscarriage.
- Severe abdominal pain and cramping.
- Evidence of retained tissue in the uterus via ultrasound.
- Symptoms of infection, such as fever and unusual discharge.
Preparation
- Fasting for 6-8 hours before the procedure if general anesthesia is used.
- Adjustments to current medications as advised by the doctor.
- Pre-procedure lab tests, including blood work and possibly an ultrasound.
Procedure Description
- The patient is given either general anesthesia (patient is asleep) or local anesthesia (numbed area).
- The cervix is dilated using graduated dilators.
- A curette (a spoon-shaped instrument) or suction device is used to remove tissue from the lining of the uterus.
- The procedure typically involves the use of a speculum, dilators, a curette, and suction curette.
- The removed tissue may be sent to a lab for further analysis.
Duration
The procedure typically takes 15-30 minutes.
Setting
Performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Obstetrician/Gynecologist (OB/GYN) or a trained surgeon.
- Anesthesiologist or nurse anesthetist.
- Nurses and surgical assistants.
Risks and Complications
- Common risks: cramping, bleeding, infection.
- Rare risks: perforation of the uterus, damage to surrounding organs, adverse reactions to anesthesia.
- Management: Monitoring post-procedure, antibiotics for infection, and additional surgery if complications arise.
Benefits
- Prompt relief from symptoms caused by retained tissue.
- Decreased risk of infection or heavy bleeding.
- Physical recovery typically begins within a few days.
Recovery
- Rest for the first 24-48 hours post-procedure.
- Avoiding strenuous activities and sexual intercourse for 1-2 weeks.
- Follow-up appointment to ensure complete recovery and no complications.
- Pain management with prescribed or over-the-counter pain relievers.
Alternatives
- Medical management with medications to expel retained tissue.
- Expectant management, allowing the body to expel tissue naturally.
- Pros/Cons: Medications may not be as immediate as surgery; expectant management can take longer and may not be fully effective.
Patient Experience
- During: If under local anesthesia, some pressure or mild discomfort may be felt; general anesthesia renders the patient unconscious.
- After: Cramping and light bleeding for a few days is common. Pain management with medication. Most patients are able to resume normal activities within a week, with some exceptions based on individual recovery.