Treatment of missed abortion, completed surgically; first trimester
CPT4 code
Name of the Procedure:
Treatment of missed abortion, completed surgically; first trimester
Summary
In layman's terms, this procedure involves the surgical removal of tissue from a missed miscarriage during the first trimester. It is often performed via dilation and curettage (D&C) or vacuum aspiration to safely clear the uterus.
Purpose
This procedure addresses the condition of a missed abortion or miscarriage. The goal is to remove pregnancy tissue from the uterus to prevent complications such as infection or heavy bleeding, and to help the patient return to their normal menstrual cycle.
Indications
The procedure is warranted if the patient experiences symptoms such as retained pregnancy tissue after a miscarriage, no fetal heart activity confirmed via ultrasound, or if medical management of miscarriage fails. Criteria include a missed abortion diagnosed in the first trimester.
Preparation
Patients may be advised to fast for a few hours before the procedure, and they might need to adjust or stop certain medications. Pre-procedure assessments include an ultrasound to confirm the diagnosis and blood tests to check overall health and blood type.
Procedure Description
- The patient is positioned on an examination table.
- Anesthesia, usually local or general, is administered.
- The cervix is dilated using a series of graduated rods.
- A curette or vacuum aspiration device is used to remove the pregnancy tissue from the uterus.
- The doctor ensures all tissue has been removed and may perform a final ultrasound to confirm this.
Duration
The procedure typically takes about 10-20 minutes.
Setting
This procedure is usually performed in a hospital, outpatient clinic, or surgical center.
Personnel
The procedure is carried out by a gynecologist or obstetrician, assisted by nurses, and potentially an anesthesiologist if general anesthesia is used.
Risks and Complications
Common risks include cramping, bleeding, and infection. Rare complications can involve uterine perforation, scarring (Asherman's syndrome), or adverse reactions to anesthesia. Management of complications may require antibiotics or additional surgical intervention.
Benefits
The expected benefits include the complete removal of pregnancy tissue, prevention of infection, and resolution of symptoms. Patients often experience a return to normal menstrual cycles within a few weeks.
Recovery
Post-procedure, patients are advised to rest and avoid strenuous activities for a few days. Pain can be managed with prescribed or over-the-counter medications. Patients should avoid inserting anything into the vagina (e.g., tampons, sexual intercourse) for a specified period, and follow-up appointments may be scheduled to ensure complete recovery.
Alternatives
Other treatment options include medical management with medication, such as misoprostol, or expectant management where the body is allowed to pass the pregnancy tissue naturally. Comparatively, surgical treatment is quicker, with a more immediate resolution, and often has fewer complications.
Patient Experience
During the procedure, under proper anesthesia, the patient typically feels little to no discomfort. Post-procedure, patients might experience cramping and light bleeding, manageable with pain relief and rest. Emotions can vary, and supportive care or counseling may be beneficial.