59812 Treatment of incomplete abortion, any trimester, completed surgically

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

1. The patient is given either general anesthesia (patient is asleep) or local anesthesia (numbed area).
2. The cervix is dilated using graduated dilators.
3. A curette (a spoon-shaped instrument) or suction device is used to remove tissue from the lining of the uterus.
4. The procedure typically involves the use of a speculum, dilators, a curette, and suction curette.
5. 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.