59821 Treatment of missed abortion, completed surgically; second trimester

Name of the Procedure:

Treatment of Missed Abortion, Completed Surgically (Second Trimester)

Summary

This surgical procedure is used to treat a missed abortion, where a fetus has died or failed to develop but has not been expelled from the uterus. This procedure typically involves a dilation and evacuation (D&E) to remove fetal tissue and ensure the uterus is clear.

Purpose

The procedure addresses missed abortion in the second trimester, preventing complications like infection or excessive bleeding. The goal is to safely and thoroughly clear the uterus, providing closure for the patient's body and promoting physical recovery.

Indications

• Diagnosed missed abortion in the second trimester (13-24 weeks gestation).
• Symptoms such as lack of fetal movement, absence of heartbeat, or declining pregnancy hormones.
• Patient's health and readiness to undergo surgery.

Preparation

• Patients may need to fast for several hours before the procedure.
• Discontinuation or adjustment of certain medications as advised by healthcare providers.
• Pre-operative blood tests, ultrasound, and possibly other diagnostics to confirm the condition and plan the procedure.

Procedure Description

1. An intravenous (IV) line is started to administer fluids and medications.
2. Anesthesia (usually general or regional) is administered.
3. The cervix is dilated using medications or mechanical dilators.
4. Surgical instruments, such as suction devices, forceps, and curettes, are used to remove fetal tissue and placental remains from the uterus.
5. The uterus is carefully examined to ensure all tissue has been removed, preventing complications like infection.

Duration

Typically lasts 30 minutes to 1 hour.

Setting

Performed in a hospital or surgical center operating room.

Personnel

• Obstetrician-gynecologist (OB-GYN) or a specialized surgeon.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and possibly a surgical technologist.

Risks and Complications

• Common: Bleeding, infection, and cramping.
• Rare: Injury to the uterus or surrounding organs, adverse reactions to anesthesia, blood clots.
• Management includes monitoring, medication, and possibly additional procedures if complications arise.

Benefits

The main benefit is the safe and complete removal of fetal tissue, reducing the risk of infection and other complications. Emotional closure and physical recovery can begin soon after the procedure.

Recovery

• Patients typically remain under observation for a few hours post-procedure.
• Comfort measures and pain medications are provided.
• Avoiding strenuous activities for a few days to weeks.
• Follow-up appointments to monitor recovery and address any concerns.

Alternatives

• Medical Management: Use of medications to induce expulsion of fetal tissue. May be less invasive but can be slower and less predictable.
• Expectant Management: Waiting for the tissues to pass naturally, which can take time and carries a risk of complications.

Patient Experience

Patients may experience cramping and light bleeding post-procedure. Emotional support and counseling are often recommended. Pain management is addressed through medication, and most patients can resume normal activities gradually within a few days.