DOCSLIB.ORG

Editorial Robert L

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Editorial Robert L Editorial Robert L. Barbieri, MD Editor in Chief A stitch in time: The B-Lynch, Hayman, and Pereira uterine compression sutures All three of these uterine compression sutures are effective at treating postpartum hemorrhage caused by uterine atony—remember to use them CASE You are performing a cesarean carboprost tromethamine (Hemabate), others. Every obstetrician should be delivery for a 30-year-old G1P0 woman and methergine do not result in resolu- proficient with the placement of at who presented in labor with a breech tion of the hemorrhage. Your assistant least one uterine compression suture fetus at term. Earlier in the pregnancy suggests a uterine compression suture for the treatment of PPH caused by an external version was unsuccessful to treat the PPH. uterine atony. in achieving a cephalic presentation. What uterine compression suture The breech delivery of the newborn would you choose? Consider the hysterotomy is uncomplicated but, immediately When it’s open. When PPH caused following delivery of the placenta, he management of PPH can by uterine atony occurs at cesarean you note excessive uterine bleeding be conveniently described delivery and the hysterotomy inci- and diagnose a postpartum hemor- T using one algorithm for cases sion is open, the B-Lynch suture rhage (PPH) due to uterine atony. that follow a vaginal delivery, and ( FIGURE 1, page 8) is a common se- Manual massage of the uterus and another algorithm for PPH that lection by obstetricians. administration of oxytocin, misoprostol, occurs during cesarean delivery (see When it’s closed. When the hys- “Managing PPH following vaginal terotomy is already closed when and cesarean delivery” on page 10). PPH is noted, the Hayman or Pereira Instant Poll If PPH does not respond to initial suture(s) are often selected by obste- treatment steps, more invasive and tricians (FIGURES 2 AND 3, page 8). resource-intensive steps should be Both of these compression sutures performed quickly. Time is critical; also could be applied when the hys- delay in initiating escalating steps in terotomy is open. In your experience, what are the treatment algorithm should be the most important clinical minimized. Combination treatment pearls concerning the place- Consider combining a uterine com- ment of uterine compression PPH at cesarean: Remember pression suture with either: sutures that you would like to your suture options! • placement of an intrauterine bal- share with our readers, your In the algorithm for the treatment of loon, the so-called uterine sandwich,4 colleagues? PPH occurring at the time of cesare- or Tell us—at an delivery, the uterine compression • uterine devascularization sutures [email protected]. suture is an important option. (O’Leary ligation of branches of uter- Please include your name In 1997, Christopher B-Lynch ine artery and ligation of the uterine- and city and state. reported1 on the first widely utilized ovarian arteries). uterine compression suture. Alterna- It’s important to note that the tive compression sutures have been combination of a uterine compres- reported by Hayman,2 Pereira,3 and sion suture with devascularization 6 OBG Management | December 2012 | Vol. 24 No. 12 obgmanagement.com Editorial FIGURE 1 B-Lynch suture sutures may be associated with a higher rate of uterine ischemia and myometrial necrosis than the com- bination of compression sutures with an intrauterine balloon.5 Placing the B-Lynch suture The B-Lynch suture (figure 1) is placed with the following steps: 1) Take bites on either side of the right edge of the hysterotomy in- cision (A and B). These bites are placed approximately 3 cm from the edge of the hysterotomy incision. 2) Loop the suture around the fun- dus and reenter the uterus through the posterior uterine wall at point C, which is directly below point B. 3) Pull the suture tightly, but do not tear into the myometrium. 4) Exit the posterior wall of the uter- us through point D. 5) Loop the suture over the uterine fundus. 6) Anchor the suture in the lower uterine segment by taking bites on either side of the left edge of the uter- ine hysterotomy incision (E and F). The B-Lynch suture as seen from the anterior uterine wall. 7) Pull the two ends of the suture tight while an assistant simultaneously FIGURE 2 Hayman suture FIGURE 3 Pereira sutures management obg r O k f oc s T r ha The Pereira sutures combine longitudinal and transverse sutures A i The Hayman suture passes directly from the anterior uterine placed as a series of bites into the submucosal myometrium. The C wall through the posterior uterine wall. Two to four longitudinal sutures do not enter the uterine cavity. The longitudinal sutures r ma sutures can be placed. Two longitudinal sutures are pictured begin and end at the level of the transverse suture closest to s: on in this figure. A transverse cervicoisthmic suture also can be the cervix. Avoid damage to blood vessels and the ureters when i at placed, if needed, to control bleeding from the lower uterine placing the transverse sutures. Two longitudinal sutures and r segment. three transverse sutures are pictured in this figure. T us ll i 8 OBG Management | December 2012 | Vol. 24 No. 12 obgmanagement.com Editorial squeezes the uterus to aid compres- sion. Managing PPH following vaginal and cesarean delivery 8) Place a surgical knot while the assistant continues to compress the The sequential treatment of PPH can be conveniently divided into two algorithms: uterus. 1. PPH following vaginal delivery 9) Close the lower uterine segment 2. PPH at cesarean delivery. in the usual manner. B-Lynch1 ad- in both situations, administration of uterotonics; uterine massage; aggressive replacement of red blood cells and clotting factors (fresh frozen plasma, cryopre- vised that if there is excessive bleed- cipitate, riastap-lyophilized fibrinogen concentrate), and platelets and monitoring ing from a specific area of the uterus of coagulation effectiveness are critically important. Eliciting the aid of additional (possible placenta accreta) that a obstetricians, anesthesiologists, and nursing staff is also essential. figure-of-8 stitch should be placed through that area of the uterus prior Managing PPH following vaginal Managing PPH at cesarean delivery delivery to placing the compression suture. • Move the patient from labor room • Ensure no retained products to operating theatre and obtain of conception Choose suture material wisely appropriate surgical anesthesia In the original description of the • Thoroughly inspect pelvis for • Identify and repair cervical and unrecognized injuries B-Lynch suture, a chromic su- vaginal lacerations ture was used.1 In a later report, • Ligate or repair lacerations of veins a No. 1 poliglecaprone-25 suture • Explore the uterus by bimanual and arteries examination and/or ultrasound (Monocryl) was utilized.6 • Uterine compression suture, for I prefer a #1 chromic suture on • Suction and/or sharp curettage example B-Lynch suture with or to remove any retained products without intrauterine balloon placement a large curved needle (Ethicon GL30, of conception 65-mm tapered needle, 30” looped • Devascularize the uterus: with suture) because the uterine com- • Place an intrauterine balloon or pack uterine artery ligation, utero-ovarian the uterus with surgical packing artery ligation pression suture only needs to main- tain suture integrity for a few days to • Interventional radiology, uterine • uterine tourniquet artery embolization be effective. As the uterus involutes • Hysterectomy • Exploratory laparotomy to a nonpregnant size, delayed ab- • Pelvic packing sorption sutures may result in long “rabbit ear” loops separated from the uterus that theoretically could trap intra-abdominal tissue. It is Some experts recommend that, PPH. The uterine compression su- important to ensure that the suture for women considering a future ture represents a significant advance selected is sufficiently long to com- pregnancy, the uterine cavity be eval- in obstetric care. Every obstetrician plete the encirclement of the uterus uated, preferably with hysteroscopy.7,8 should be facile in placing at least and with sufficient residual length to Hysterosalpingogram, hys terosono- one type of compression suture. facilitate tying the knot. graphy, and MRI are alternative options for evaluating the uterus. Evaluate for postop complications Sutures are effective when used [email protected] Following recovery from a PPH When PPH is caused by uterine treated with a uterine compression atony, compression sutures have Dr. Barbieri reports no financial rela- suture, some women develop uter- been reported to effectively man- tionships relevant to this article. ine complications such as: age the hemorrhage in about 80% to References • hematometra 90% of cases if the suture is placed 1. B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. • pyometra in an expedient manner.9–11 The in- The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative • Asherman’s syndrome troduction of uterine compression to hysterectomy? Five cases reported. Br J Obstet • localized areas of uterine necrosis sutures has helped to significantly Gynaecol. 1997;104(3):372–375. and full-thickness defects in the lower reduce the number of women who 2. Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management uterine segment or uterine fundus. undergo hysterectomy following a of postpartum hemorrhage. Obstet Gynecol. 10 OBG Management | December 2012 | Vol. 24 No. 12 obgmanagement.com 2002;99(3):502–506. 6. Price N, B-Lynch C. Technical description of the B- maran S. Systematic review of conservative man- 3. Pereira A, Nunes F, Pedroso S, Saraiva J, Retto H, Lynch brace suture for treatment of massive post- agement of postpartum hemorrhage: what to do Meirinho M. Compressive uterine sutures to treat partum hemorrhage and review of published cas- when medical treatment fails. Obstet Gynecol postpartum bleeding secondary to uterine atony. es. Int J Fertil Womens Med.
Load more

Recommended publications
  • AAGL Practice Report: Practice Guidelines for Management of Intrauterine Synechiae
    Special Article AAGL Practice Report: Practice Guidelines for Management of Intrauterine Synechiae AAGL ADVANCING MINIMALLY INVASIVE GYNECOLOGY WORLDWIDE Background The search was not restricted to English language literature; committee members fluent in languages other than English re- Intrauterine adhesions (IUAs) have been recognized as viewed relevant articles and provided the committee with rel- a cause of secondary amenorrhea since the end of the 19th ative information translated into English. Because of the century [1], and in the mid-20th century, Asherman further paucity of data in this area, all published works were included described the eponymous condition occurring after preg- for the electronic database searches, and relevant articles not nancy [2]. The terms ‘‘Asherman syndrome’’ and IUAs are available in electronic sources (e.g., published before the be- often used interchangeably, although the syndrome requires ginning of electronic database commencement) were cross- the constellation of signs and symptoms (in this case, pain, referenced from hand-searched bibliographies and included menstrual disturbance, and subfertility in any combination) in the literature review. When necessary, authors were con- and the presence of IUAs [2]. The presence of IUAs in the tacted directly for clarification of points published. absence of symptoms may be best referred to as asymptom- atic IUAs or synechiae. Diagnosis Identification and Assessment of Evidence In women with suspected IUAs, physical examination usually fails to reveal abnormalities [3,4]. Blind transcervical This AAGL Practice Guideline was produced after elec- sounding of the uterus may reveal cervical obstruction at or tronic resources including Medline, PubMed, CINAHL, the near the level of the internal os [3].
    [Show full text]
  • Comparison of Curettage and Hysteroscopy Plus Curettage After Uterine Arterial Embolization in the Treatment of Cesarean Scar Pregnancy
    Comparison of Curettage and Hysteroscopy Plus Curettage After Uterine Arterial Embolization in the Treatment of Cesarean Scar Pregnancy Lili Cao Women's Hospital, Zhejiang University School of Medicine Zhida Qian Women's Hospital, Zhejiang University School of Medicine Lili Huang ( [email protected] ) Women's Hospital, Zhejiang University School of Medicine https://orcid.org/0000-0002-5919-3172 Research article Keywords: Cesarean scar pregnancy, Hysteroscopy, Curettage, Uterine artery embolization Posted Date: July 2nd, 2020 DOI: https://doi.org/10.21203/rs.3.rs-39244/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/11 Abstract Background: Caesarean scar pregnancy (CSP) stands for the advanced stage severe complication secondary to cesarean section, and its incidence shows an increasing trend recently. However, no consensus has been reached about the optimal CSP treatment. Methods: The childbearing CSP patients with a cesarean section history were evaluated by ultrasonography, with a gestational age of less than 10 weeks. 34 patients receiving dilation and curettage (D&C) and uterine artery embolization (UAE) were enrolled into the D&C group, while 46 undergoing hysteroscopy (H/S) and D&C after UAE were enrolled into the H/S+D&C group. Results: Differences in success rate and decrease in the β-hCG level in serum on the second day of surgery were not signicant between D&C and H/S+D&C groups (P>0.05). Also, differences in side effect rate, intraoperative blood loss amount, postoperative bleeding time, and total length of stay were not signicant between both groups (P>0.05).
    [Show full text]
  • (8Th Edition) Procedure Code ACHI (8
    Appendix 1. Procedure and Diagnostic Codes Used to Identify Prior Procedures Procedure ACHI (8th ACHI (8th edition) procedure names ICD-10- ICD-10-AM edition) AM diagnosis name procedure diagnosis code code Gynecological laparoscopy 35638-00 Laparoscopic wedge resection of ovary 35638-01 Laparoscopic partial oophorectomy 35638-02 Laparoscopic oophorectomy, unilateral 35638-03 Laparoscopic oophorectomy,bilateral 35638-04 Laparoscopic ovarian cystectomy, unilateral 35638-05 Laparoscopic ovarian cystectomy, bilateral 35638-06 Laparoscopic salpingotomy 35638-07 Laparoscopic partial salpingectomy, unilateral 35638-08 Laparoscopic partial salpingectomy, bilateral 35638-09 Laparoscopic salpingectomy, unilateral 35638-10 Laparoscopic salpingectomy, bilateral 35638-11 Laparoscopic salpingo-oophorectomy, unilateral 35638-12 Laparoscopic salpingo-oophorectomy, bilateral 35638-14 Laparoscopic uterosacral nerve ablation 35637-02 Laparoscopic diathermy of lesion of pelvic cavity 35637-04 Laparoscopic ventrosuspension 35637-07 Laparoscopic rupture of ovarian cyst or abscess 35637-08 Laparoscopic ovarian drilling 35637-10 Laparoscopic excision of lesion of pelvic cavity 35729-00 Laparoscopic transposition of ovary 90430-00 Laparoscopic repair of ovary 90433-00 Other laparoscopic repair of fallopian tube 35694-00 Laparoscopic salpingoplasty 35694-01 Laparoscopic anastomosis of fallopian tube 35694-02 Laparoscopic salpingolysis 35694-03 Laparoscopic salpingostomy 35694-06 Laparoscopic salpingotomy 35649-01* Myomectomy of uterus via laparoscopy Hysteroscopy, including operative hysteroscopy 35630-00 Diagnostic hysteroscopy 35649-00 Hysterotomy 35633-00 Division of uterine adhesions 35634-00 Division of uterine septum via hysteroscopy 35649-02 Division of uterine septum via hysterotomy 35633-01 Polypectomy of uterus via hysteroscopy 35623-00 Myomectomy of uterus via hysteroscopy Baldwin HJ, Patterson JA, Nippita TA, Torvaldsen S, Ibiebele I, Simpson JM, et al. Antecedents of abnormally invasive placenta in primiparous women: the risk from gynecologic procedures.
    [Show full text]
  • Physicians As Assistants at Surgery: 2016 Update
    Physicians as Assistants at Surgery: 2016 Update Participating Organizations: American College of Surgeons American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of Otolaryngology – Head and Neck Surgery American Association of Neurological Surgeons American Pediatric Surgical Association American Society of Colon and Rectal Surgeons American Society of Plastic Surgeons American Society of Transplant Surgeons American Urological Association Congress of Neurological Surgeons Society for Surgical Oncology Society for Vascular Surgery Society of American Gastrointestinal Endoscopic Surgeons The American College of Obstetricians and Gynecologists The Society of Thoracic Surgeons Physicians as Assistants at Surgery: 2016 Update INTRODUCTION This is the seventh edition of Physicians as Assistants at Surgery, a study first undertaken in 1994 by the American College of Surgeons and other surgical specialty organizations. The study reviews all procedures listed in the “Surgery” section of the 2016 American Medical Association’s Current Procedural Terminology (CPT TM). Each organization was asked to review new codes since 2013 that are applicable to their specialty and determine whether the operation requires the use of a physician as an assistant at surgery: (1) almost always; (2) almost never; or (3) some of the time. The results of this study are presented in the accompanying report, which is in a table format. This table presents information about the need for a physician as an assistant at surgery. Also, please note that an indication that a physician would “almost never” be needed to assist at surgery for some procedures does NOT imply that a physician is never needed. The decision to request that a physician assist at surgery remains the responsibility of the primary surgeon and, when necessary, should be a payable service.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Transabdominal Cerclage: Different Indications, Optimal Outcome
    ISSN: 2474-1353 Sabr and Yousef. Int J Womens Health Wellness 2018, 4:067 DOI: 10.23937/2474-1353/1510067 Volume 4 | Issue 1 International Journal of Open Access Women’s Health and Wellness CASE REPORT Transabdominal Cerclage: Different Indications, Optimal Outcome. Two Case Reports Yasser Sabr* and Sara W Yousef Check for Department of Obstetrics and Gynecology, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia updates *Corresponding author: Yasser Sabr, Department of Obstetrics and Gynecology, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia, E-mail: [email protected] Abstract Case 1 Transabdominal placement of a cerclage at the cervicoisth- 25-years-old woman gravida 2 para 0 abortus 1 mic junction appears to be a safe and effective procedure known case of congenital hypoplastic upper vagina, for for reducing the incidence of spontaneous pregnancy loss that she underwent multiple vaginal surgeries including in selected patients with cervical insufficiency, we reported a case series of two woman with different indications for ab- vaginal septum resection, vaginoplasty (vaginostomy). dominal cerclage. Case 1 is a 25-years-old woman gravida After the procedures, Patient was unable to get preg- 2 para 0 abortus 1 known case of hypoplastic upper vagina nant for 1 year, so she came back and hysteroscopy who had 2 vaginal repair (vaginostomy) and had abdominal with examination under anesthesia was done, which cerclage for short cervix and delivered by caesarean sec- revealed stenosed upper vagina and very short cervix tion at 38 weeks a healthy baby boy. Case 2 is a 34-years- old woman gravida 5 para 0 abortus 4 known case of dia- with normal uterine cavity.
    [Show full text]
  • Tropjrnal Vol 29 No 2
    Trop J Obstet Gynaecol, 29 (2), August 2012 VAGINOPLASTY CASE SERIES AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN *Dr. Olumuyiwa A. Roberts **Dr. Olukayode A. Iyun *Dr. Michael A. Okunlola *Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan Ibadan. P.M.B. 5017 **Department of Plastic Surgery Division of Surgery, College of Medicine, University of Ibadan, Ibadan. ABSTRACT Transverse vaginal septum is a benign condition with the septum occurring at various levels within the vagina; it may occur in the upper third, mid-vaginal or lower third. A report of five cases of transverse vaginal septum managed at the University College Hospital between January, 2006 and December, 2009. Three were cases of congenital transverse vaginal septum while the other two were cases of acquired transverse vaginal septum. Diagnosis of congenital transverse vaginal septum was made following history of primary amenorrhea, pelvic examination revealing a vaginal septum. In addition, a pelvic mass and ultrasound findings of haematocolpos and haematometria were present in the first case. Diagnosis of acquired vaginal septum was made following history of secondary amenorrhea, cyclical abdominal pain and pelvic examination findings of gynaetresia and vaginal septum. In all but one, surgical resection of the transverse vaginal septum was performed, followed by lining of the vagina by split thickness skin graft (STSG): the McIndoe-Read operation. All the procedures were performed in conjunction with the Plastic surgeon. They were seen at the Gynaecology clinic post operatively at two weeks, six weeks, three and six months respectively. Four out of the five cases successfully menstruated following surgery. The fifth case was lost to follow up.
    [Show full text]
  • Procedure Codes Section 5
    NEW YORK STATE MEDICAID PROGRAM PHYSICIAN – PROCEDURE CODES SECTION 5 - SURGERY Physician – Procedure Codes, Section 5 - Surgery _____________________________________________________________________________ Table of Contents ANESTHESIA SECTION------------------------------------------------------------------------2 GENERAL INFORMATION AND RULES------------------------------------------------2 CALCULATION OF TOTAL ANESTHESIA VALUES --------------------------------4 SURGERY SECTION ----------------------------------------------------------------------------5 GENERAL INFORMATION AND RULES------------------------------------------------5 SURGERY SERVICES ------------------------------------------------------------------------ 11 GENERAL -------------------------------------------------------------------------------------- 11 INTERGUMENTARY SYSTEM ----------------------------------------------------------- 11 MUSCULOSKELETAL SYSTEM--------------------------------------------------------- 38 RESPIRATORY SYSTEM ---------------------------------------------------------------- 108 CARDIOVASCULAR SYSTEM --------------------------------------------------------- 123 HEMIC AND LYMPHATIC SYSTEMS ------------------------------------------------ 167 MEDIASTINUM AND DIAPHRAGM --------------------------------------------------- 170 DIGESTIVE SYSTEM---------------------------------------------------------------------- 171 URINARY SYSTEM ------------------------------------------------------------------------ 214 MALE GENITAL SYSTEM ---------------------------------------------------------------
    [Show full text]
  • When Does Hysterectomy Replace Myomectomy in Benign Uterine Pathology? - L
    International Journal of Reproductive Medicine & Gynecology Review Article When does Hysterectomy Replace Myomectomy in Benign Uterine Pathology? - L. Mettler* and I. Alkatout Department of Obstetrics & Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany *Address for Correspondence: Liselotte Mettler, Department of Obstetrics & Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany, Tel: +49 431 500 21450; E-mail: [email protected] Submitted: 06 December 2016; Approved: 20 April 2017; Published: 28 April 2017 Citation this article: Mettler L, Alkatout I. When does Hysterectomy Replace Myomectomy in Benign Uterine Pathology? SRL Reprod Med Gynecol. 2017;3(1): 010-019. Copyright: © 2017 Mettler L, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. International Journal of Reproductive Medicine & Gynecology Abstract Uterine fi broids are the most frequent benign tumors of the female genital tract. Fibroids are associated with a variety of clinical problems, e.g. pain, bleeding disorders, bulk-related symptoms or infertility. For women wishing to preserve their uterus, fi broids can be surgically removed by hysteroscopy, laparoscopy or laparotomy. While hysterectomy remains the only defi nitive solution, many alternative treatment possibilities of uterine preservation are available today. The indication for treatment has to be taken carefully after weighing up alternative treatment methods, such as expectant management, medical treatment or interventional radiologic methods, and after obtaining informed consent. The optimal method of treatment takes into account the patient’s interests and wishes and the practical feasibility in the clinical setup.
    [Show full text]
  • Measure Name: Cervical Cancer Screen
    Measure Name: Cervical Cancer Screen Owner: NCQA (CCS) Measure Code: CER Lab Data: Y Rule Description: The percentage of women 21-64 years of age who received one or more Pap tests to screen for cervical cancer. Applicable Provider Specialty: Family Practice, Internal Medicine, Mixed Specialties Clinic, Obstetrics-Gynecology General Criteria Summary 1. Continuous enrollment: 3 year 2. Anchor date: 31st December of the measurement year 3. Gaps in enrollment: One 45-day gap allowed in each year of continuous enrollment 4. Medical coverage: Yes 5. Drug coverage: No 6. Attribution time frame:2 year 7. Exclusions apply: Yes, when numerator is negative 8. Age range: 21-64 years Summary of changes for 2011 Added CPT codes 57540, 57545, 57550, 57555, 57556, and 58548 to Table CCS-B: Codes to Identify Exclusions ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Denominator Description: All women aged 24-64 years at the end of the measurement year Inclusion Criteria: Women who meet the age requirement in the measurement year and continuous enrollment criteria as summarized above for the coverage required. There are no claims criteria for the denominator population. Eligibility Criteria Condition # Detailed Criteria Timeframe Description Evnt Gender Code Gender Code = F AND Age is 24-64 Age in Years = 24-64 As of the end of the measurement year AND Has medical coverage Coverage Indicator
    [Show full text]
  • Comprehensive Cervical Cancer Control a Guide to Essential Practice
    Comprehensive Cervical Cancer Control A guide to essential practice Second edition Comprehensive cervical cancer control A guide to essential practice WHO Library Cataloguing-in-Publication Data Comprehensive cervical cancer control: a guide to essential practice – 2nd ed 1.Uterine Cervical Neoplasms - diagnosis. 2.Uterine Cervical Neoplasms - prevention and control. 3.Uterine Cervical Neoplasms – therapy. 4.Guideline. I.World Health Organization. ISBN 978 92 4 154895 3 (NLM classification: WP 480) © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • Laparoscopic Removal of Abdominal Cerclage and Vaginal Delivery at 21 Weeks
    CASE REPORT Laparoscopic Removal of Abdominal Cerclage and Vaginal Delivery at 21 Weeks Alex Ades, MD, PhD, Kim C. Dobromilsky, BMBS, BPharm AGORA Centre for Women’s Health, Epworth Hospital, Melbourne, Victoria, Australia (both authors). ABSTRACT Introduction: Transabdominal cerclage (TAC) is a procedure for cervical insufficiency in women in whom transvaginal cerclage cannot be performed. In recent years, laparoscopic transabdominal cerclage has gained favor by eliminating the need for laparotomy and reducing surgical morbidity. Case Description: We present a case of laparoscopic removal of a TAC in a 27-year-old woman with uterus didelphys, who presented with fetal death in utero at 21 weeks 3 days. Conclusion: This successful, minimally invasive technique eliminated the need for hysterotomy and the potential corresponding morbidity associated with the operation and allowed for normal spontaneous vaginal delivery. Key Words: Hysterotomy, Transabdominal cerclage, Transvaginal cerclage, Uterine malformation, Uterus didelphys. Citation Ades A, Dobromilsky KC. Laparoscopic removal of abdominal cerclage and vaginal delivery at 21 weeks. CRSLS e2014.00247. DOI: 10.4293/CRSLS.2014.00247. Copyright © 2015 by SLS, Society of Laparoendoscopic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 3.0 Unported license, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. Address correspondence to: Kim C. Dobromilsky, BM, BS, AGORA Centre for Women’s Health, Epworth Hospital, Melbourne, Victoria, Australia. Tel: ϩ61-3-9421- 2533, Fax ϩ61-3-9429-7407, E-mail: [email protected] INTRODUCTION procedure carries significant surgical morbidity with pos- sible long-term complications and negative implications Transabdominal cerclage (TAC) has been described as a for future pregnancies.
    [Show full text]