Induced abortion, by 1 or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation
CPT4 code
Name of the Procedure:
Induced Abortion via Intra-Amniotic Injections, also known as Amniocentesis Injections with Dilation and Curettage (D&C) and/or Evacuation
Summary
This procedure involves the termination of pregnancy through one or more injections into the amniotic sac, followed by the delivery of the fetus and placental tissue (secundines). A dilation and curettage (D&C) or evacuation might be performed to ensure complete removal of fetal and placental tissue. This procedure typically requires hospital admission and may involve several visits.
Purpose
The procedure is intended to safely terminate a pregnancy. The expected outcome is the complete removal of the fetus and placental tissues to prevent complications associated with incomplete abortion.
Indications
Indications for this procedure include:
- Severe fetal anomalies incompatible with life
- Maternal conditions warranting termination to save the mother's life
- Failure of a pregnancy to progress (incomplete miscarriage)
- Personal decision to terminate the pregnancy within the legal limits
Preparation
- Fasting may be required for a few hours before the procedure.
- Patients may need to stop taking certain medications as directed by their physician.
- Diagnostic tests such as ultrasounds and blood work will be conducted to confirm the gestational age and assess health status.
Procedure Description
- Hospital Admission: The patient is admitted and prepped for the procedure.
- Anesthesia: Regional anesthesia (epidural or spinal) or general anesthesia is administered.
- Amniocentesis: A needle is inserted through the abdomen into the amniotic sac under ultrasound guidance, and medications are injected to induce fetal demise.
- Labor Induction: Medications to induce labor may be administered.
- Delivery: The fetus and secundines are delivered vaginally.
Dilation and Curettage (D&C) or Evacuation: If any tissue remains, a D&C or evacuation is performed to ensure complete removal of all tissues.
Duration
The procedure can take several hours, including the time for labor induction and delivery.
Setting
The procedure is performed in a hospital setting, often in a dedicated labor and delivery unit or operating room.
Personnel
- Obstetrician/Gynecologist (OB/GYN)
- Anesthesiologist
- Nursing staff
- Ultrasound technician
Risks and Complications
- Infection
- Heavy bleeding
- Perforation of the uterus
- Incomplete abortion requiring further intervention
- Adverse reaction to anesthesia
- Emotional and psychological impact
Benefits
- Safe and effective termination of pregnancy
- Prevention of complications related to non-viable pregnancies
- Potential improvement in maternal health conditions requiring termination
Recovery
- Post-procedure, patients may stay in the hospital for observation.
- Mild cramping and bleeding are expected.
- Pain medications are provided as needed.
- Follow-up visits are scheduled to ensure complete recovery and address any complications.
- Patients are usually advised to avoid strenuous activities and sexual intercourse for a few weeks.
Alternatives
- Medical abortion using oral medications
- Vacuum aspiration procedure
- Continuation of pregnancy (if an option)
- Each alternative has its own risks and benefits, which should be discussed with the healthcare provider.
Patient Experience
- Pain management is provided to ensure comfort.
- Patients may experience emotional distress and should have access to psychological support services.
- Physical recovery typically takes a few days to a few weeks, but emotional recovery may take longer.
- Support from family, friends, and counseling services is recommended.