DOCSLIB.ORG

Pelvic Floor Disorders After Vaginal Birth Effect of Episiotomy, Perineal Laceration, and Operative Birth

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pelvic Floor Disorders After Vaginal Birth Effect of Episiotomy, Perineal Laceration, and Operative Birth Pelvic Floor Disorders After Vaginal Birth Effect of Episiotomy, Perineal Laceration, and Operative Birth Victoria L. Handa, MD, MHS, Joan L. Blomquist, MD, Kelly C. McDermott, BS, Sarah Friedman, MD, and Alvaro Mun˜oz, PhD OBJECTIVE: To investigate whether episiotomy, perineal who experienced at least one forceps birth (compared laceration, and operative delivery are associated with with delivering all her children by spontaneous vaginal pelvic floor disorders after vaginal childbirth. birth). METHODS: This is a planned analysis of data for a cohort CONCLUSION: Forceps deliveries and perineal lacera- study of pelvic floor disorders. Participants who had tions, but not episiotomies, were associated with pelvic experienced at least one vaginal birth were recruited floor disorders 5–10 years after a first delivery. 5–10 years after delivery of their first child. Obstetric (Obstet Gynecol 2012;119:233–9) exposures were classified by review of hospital records. DOI: 10.1097/AOG.0b013e318240df4f At enrollment, pelvic floor outcomes, including stress LEVEL OF EVIDENCE: II incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated ques- tionnaire. Pelvic organ support was assessed using the mong parous women, cesarean birth reduces the 1 Pelvic Organ Prolapse Quantification system. Logistic Aodds of pelvic floor disorders later in life. How- regression analysis was used to estimate the relative odds ever, most U.S women deliver vaginally. Therefore, it of each pelvic floor disorder by obstetric history, adjust- is important to identify labor interventions that in- ing for relevant confounders. crease the risk of pelvic floor disorders after vaginal RESULTS: Of 449 participants, 71 (16%) had stress incon- childbirth. tinence, 45 (10%) had overactive bladder, 56 (12%) had One area of substantial controversy is the role of anal incontinence, 19 (4%) had prolapse symptoms, and episiotomy and spontaneous perineal laceration. Al- 64 (14%) had prolapse to or beyond the hymen on most 80 years ago, episiotomy was proposed as a examination. Forceps delivery increased the odds of each strategy to prevent spontaneous laceration and to pelvic floor disorder considered, especially overactive thereby reduce “pelvic relaxation.”2 Specifically, su- bladder (odds ratio [OR] 2.92, 95% confidence interval perior pelvic organ support was observed 6 weeks [CI] 1.44–5.93), and prolapse (OR 1.95, 95% CI 1.03–3.70). postpartum among women who had received episiot- Episiotomy was not associated with any of these pelvic omy.2–4 However, more recent studies have suggested floor disorders. In contrast, women with a history of that episiotomy may increase the odds of pelvic floor more than one spontaneous perineal laceration were disorders.5–7 Thus, the role of episiotomy is uncertain. significantly more likely to have prolapse to or beyond A 2005 systematic review concluded that the effect of the hymen (OR 2.34, 95% CI 1.13–4.86). Our multivari- episiotomy on the development of pelvic floor disor- able results suggest that one additional woman would 8 have development of prolapse for every eight women ders remains unknown. Also controversial is the association between op- erative delivery and pelvic floor disorders. Although From the Department Gynecology and Obstetrics, Johns Hopkins School of Medicine, the Department of Obstetrics and Gynecology, Greater Baltimore some research has suggested that operative delivery Medical Center, and the Department of Epidemiology, Johns Hopkins Bloomberg substantially increases the odds for pelvic floor disor- School of Public Health, Baltimore, Maryland. ders,1 other research suggests that operative birth is Supported by the Eunice Kennedy Shriver National Institute of Child Health not a strong predictor of urinary incontinence9–14 or and Human Development (R01HD056275). pelvic organ prolapse (POP).7 Corresponding author: Victoria L. Handa, MD, MHS, 4940 Eastern Avenue, 301 Building, Baltimore, MD 21224; e-mail: [email protected]. In this research, we investigated putative risk factors for pelvic floor disorders 5–10 years after © 2012 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. childbirth among women who had at least one vagi- ISSN: 0029-7844/12 nal birth. This was a planned secondary aim of the VOL. 119, NO. 2, PART 1, FEBRUARY 2012 OBSTETRICS & GYNECOLOGY 233 Mothers’ Outcomes After Delivery study, a longitu- delivery) was classified as prolonged if more than 2 dinal cohort study of pelvic floor disorders after hours. Macrosomia was defined as neonatal birth childbirth. In this analysis, we focused on whether weight of 4,000 g or more. Although all participants operative delivery, episiotomy, and spontaneous per- had their first delivery at our institution, some partic- ineal laceration were associated with the later devel- ipants delivered a subsequent child at a different opment of pelvic floor disorders among vaginally hospital. For these deliveries, we relied on the wom- parous women. Our goal was to identify modifiable an’s reported description of all obstetric events. obstetric risk factors for pelvic floor disorders. In addition to obstetric exposures, we considered the confounders of race, parity, maternal age at the MATERIALS AND METHODS time of first delivery, and obesity. Race and parity The Mothers’ Outcomes after Delivery study is a were self-reported at study enrollment. Obesity was prospective cohort study of pelvic floor outcomes in also determined at study enrollment. Specifically, women recruited 5–10 years after delivery of their each participant’s weight and height were measured first child.1 Institutional Review Board approval was and body mass index was calculated (weight (kg)/ obtained from Johns Hopkins Medicine Institutional [height (m)]2). Obesity was defined as a body mass Reviewer Board and the Greater Baltimore Medical index of 30 or more. Center Review Board, and all participants provided The outcomes of interest were the presence or written informed consent. Recruitment of women into absence of pelvic floor disorders, evaluated at the the study began in 2008 and is ongoing. The recruit- enrollment visit. We used the Epidemiology of Pro- ment methods have been described in detail else- lapse and Incontinence Questionnaire, a validated where.1 To be eligible, women must have given birth self-administered questionnaire,15 to identify women to their first child at Greater Baltimore Medical with bothersome symptoms of pelvic floor disorders. Center 5–10 years before enrollment. Participants This questionnaire generates scores for four pelvic were identified from obstetric hospital discharge re- floor disorders: stress urinary incontinence, overac- cords. To verify eligibility and to confirm delivery tive bladder, anal incontinence, and POP. In each type, each hospital chart was reviewed by a member case, a validated threshold is used to define women of our research team who was also an obstetrician. who meet criteria for the disorder. Scores greater than Obstetric exposures were derived from abstrac- these threshold values have been shown to corre- tion of all delivery records for each participant. The spond to clinically significant bother from pelvic floor exposures of primary interest were forceps and vac- symptoms.15 We used the published thresholds to uum delivery, episiotomy, and spontaneous perineal distinguish women with and without each pelvic floor laceration. These were classified after chart abstrac- disorder. tion. If relevant data were missing from the medical In addition to the research questionnaire, a gyne- record, then the participant’s recall was used to cologic examination was performed to assess pelvic classify her birth. With respect to laceration and organ support using the Pelvic Organ Prolapse Quan- episiotomy, we considered the following as mutually tification examination system.16 The examination was exclusive at the delivery level: intact perineum; epi- performed by physicians and a research nurse, each siotomy (with or without extension to grade 3–4); and of whom demonstrated competency in performing grade 1–2 spontaneous perineal laceration (with or the research examination before the study; compe- without extension to grade 3–4). A delivery without tency was reconfirmed throughout the study. At the an episiotomy or laceration was classified as intact time of each examination, the clinician was blinded to perineum. Midline and mediolateral episiotomies the woman’s delivery history and her symptoms. were considered as a single group because only 8% of Women were classified as having objective evidence episiotomies in this population were classified as of POP if the most dependent point of the vaginal wall mediolateral. Although these perineal exposures (epi- or the cervix came to or beyond the hymen.1,17,18 siotomy, laceration, or intact) were defined in mutu- At enrollment into our cohort study, participants ally exclusive categories at each delivery, they were were asked about previous treatment for pelvic floor combined for each woman across all her deliveries for disorders, including surgery and pelvic muscle exer- analysis. cises (if the program was professionally supervised). Additional obstetric data were also abstracted Participants were also asked about current therapy, from the obstetric chart, including the duration of the including medications for urinary incontinence or second stage and the birth weight. The duration of the current pessary use
Load more

Recommended publications
  • 1063 Relation Between Vaginal Hiatus and Perineal Body
    1063 Campanholi V1, Sanches M1, Zanetti M R D1, Alexandre S1, Resende A P M1, Petricelli C D1, Nakamura M U1 1. Unifesp- Brasil RELATION BETWEEN VAGINAL HIATUS AND PERINEAL BODY LENGTHS WITH EPISIOTOMY IN VAGINAL DELIVERY Hypothesis / aims of study The aim of the study was to assess the relationship between vaginal hiatus and perineal body lengths with the occurrence of episiotomy during vaginal delivery. Study design, materials and methods It´s a cross-sectional observational study with a consecutive sample of 60 parturients, made from July 2009 to March 2010 in the Obstetric Center at University Hospital in São Paulo, Brazil. Inclusion criteria were parturients at term (37 to 42 weeks gestation) in the first stage of labour, with less than 9 cm dilatation, with a single fetus in cephalic presentation and good vitality confirmed by cardiotocography. Exclusion criteria were parturients submitted to cesarean section or forceps delivery. The patients were evaluated in the lithotomic position. The measurement was performed in the first stage of labour, by the same examiner using a metric measuring tape previously cleaned with alcohol 70% and discarded after each use. The vaginal hiatus length (distance between the external urethral meatus and the vulvar fourchette) and the perineal body (distance between the vulvar fourchette and the center of the anal orifice) were evaluated. For statistical analysis the SPSS (Statistical Package for Social Sciences) version 17® was used, applying Mann-Whitney Test and Spearman Rank Correlation Test to determine the importance of vaginal hiatus and perineal body length in the occurrence of episiotomy, with p<0.05.
    [Show full text]
  • Leapfrog Hospital Survey Hard Copy
    Leapfrog Hospital Survey Hard Copy QUESTIONS & REPORTING PERIODS ENDNOTES MEASURE SPECIFICATIONS FAQS Table of Contents Welcome to the 2016 Leapfrog Hospital Survey........................................................................................... 6 Important Notes about the 2016 Survey ............................................................................................ 6 Overview of the 2016 Leapfrog Hospital Survey ................................................................................ 7 Pre-Submission Checklist .................................................................................................................. 9 Instructions for Submitting a Leapfrog Hospital Survey ................................................................... 10 Helpful Tips for Verifying Submission ......................................................................................... 11 Tips for updating or correcting a previously submitted Leapfrog Hospital Survey ...................... 11 Deadlines ......................................................................................................................................... 13 Deadlines for the 2016 Leapfrog Hospital Survey ...................................................................... 13 Deadlines Related to the Hospital Safety Score ......................................................................... 13 Technical Assistance.......................................................................................................................
    [Show full text]
  • Maternity Information for Childbirth Services
    Maternity information for childbirth services What you need to know 20905-3-17 New York State’s Maternity Information Law requires each hospital to provide the following information about its childbirth practices and procedures. This information will help you to better understand what to expect, learn more about your childbirth choices, and plan for your baby’s birth. Data shown are for 2014. Most of the information is given in percentages of all deliveries occurring in the hospital during a given year. For example, if 20 births out of 100 are by cesarean section, the cesarean section rate will be 20 percent. If external fetal monitoring is used in 50 out of 100 births, or one-half of all births, the rate will be 50 percent. This information alone doesn’t tell you that one hospital is better than another. If a hospital has fewer than 200 births per year, the use of special procedures in just a few births could change its rates. The types of births could affect the rates as well. Some hospitals offer specialized services to women who are expected to have complicated or high-risk births, or whose babies are not expected to develop normally. These hospitals can be expected to have higher rates of the special procedures than hospitals that do not offer these services. This information also does not tell you about your doctor’s or nurse-midwife’s practice. However, the information can be used when discussing your wishes with your doctor or nurse-midwife, and to find out if his or her use of special procedures is similar to or different from that of the hospital.
    [Show full text]
  • Guide on Health 2015-2016 There Are Many Important Topics to Consider with Regard to Pregnancy and Delivery
    PLANNING A HEALTHY START Why Maternity Care is Important CONSUMER GUIDE ON HEALTH 2015-2016 THERE ARE MANY IMPORTANT TOPICS TO CONSIDER WITH REGARD TO PREGNANCY AND DELIVERY. USE THIS GUIDE TO LEARN HOW TO MAKE THE BEST CHOICES FOR MATERNITY CARE. BOOMING: Can you believe nearly 4 million babies were born in 2014? That’s roughly 11,000 each day! The 2014 number of births marks the first increase since 2007. Source: CDC, National Vital Statistics Reports, Vol 64 No 6. PLANNING A HEALTHY START What NOT to Eat When You Are Pregnant & MAINTAINING A HEALTHY Unpasturized (soft) cheeses such as brie, feta, PREGNANCY or bleu cheese, as they may contain listeria (a bacteria that can be fatal to your baby). Checklist for a Healthy Start: Deli meat or hot dogs unless cooked to steaming to eliminate possible listeria. Take 400 mcg of Folic Acid daily to prevent Neural Tube Defects (NTD) Fish containing high levels of mercury, such as If you smoke, QUIT! swordfish. You can safely consume up to 12 oz. of Avoid consuming alcohol. seafood per week, as long as it is low in mercury. Receive a flu shot to protect you and your baby. Raw sprouts, as bacteria can get into If you are diabetic, maintain control of it to the seeds before they grow. prevent complications. Talk to your doctor about any medications you Potluck dishes that have been are on and their safety during pregnancy. sitting out for 2 hours or more. Source: CDC Source: WebMD Folic Acid: An Important Foundation Tips for a Healthy Diet Women of childbearing age should get 400 GRAINS micrograms of Folic Acid (a B vitamin) EACH day.
    [Show full text]
  • • Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion –
    • Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion – Oligohydramnios – Umbilical cord compression – Reduction of recurrent variable decelerations – Dilution of meconium-stained amniotic fluid – Replaces the “cushion ” for the umbilical cord and relieves the variable decelerations • Obstetric Procedures (cont.) • Amniotomy – The artificial rupture of membranes – Done to stimulate or enhance contractions – Commits the woman to delivery – Stimulates prostaglandin secretion – Complications • Prolapse of the umbilical cord • Infection • Abruptio placentae • Obstetric Procedures (cont.) • Observe for complications post-amniotomy – Fetal heart rate outside normal range (110-160 beats/min) suggests umbilical cord prolapse – Observe color, odor, amount, and character of amniotic fluid – Woman ’s temperature 38 ° C (100.4 ° F) or higher is suggestive of infection – Green fluid may indicate that the fetus has passed a meconium stool • Nursing Tip • Observe for wet underpads and linens after the membranes rupture. Change them as often as needed to keep the woman relatively dry and to reduce the risk for infection or skin breakdown. • Induction or Augmentation of Labor • Induction is the initiation of labor before it begins naturally • Augmentation is the stimulation of contractions after they have begun naturally • Indications for Labor Induction • Gestational hypertension • Ruptured membranes without spontaneous onset of labor • Infection within the uterus • Medical problems in the
    [Show full text]
  • Pretest Obstetrics and Gynecology
    Obstetrics and Gynecology PreTestTM Self-Assessment and Review Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the prod- uct information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Obstetrics and Gynecology PreTestTM Self-Assessment and Review Twelfth Edition Karen M. Schneider, MD Associate Professor Department of Obstetrics, Gynecology, and Reproductive Sciences University of Texas Houston Medical School Houston, Texas Stephen K. Patrick, MD Residency Program Director Obstetrics and Gynecology The Methodist Health System Dallas Dallas, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc.
    [Show full text]
  • NTSV: Accurate Coding for Improved Quality Measures Program III: OB Procedure Coding Module 3: Delivery and Procedures Assisting Delivery Grant Acknowledgement
    NTSV: Accurate Coding for Improved Quality Measures Program III: OB Procedure Coding Module 3: Delivery and Procedures Assisting Delivery Grant Acknowledgement Funding for this training series was made possible by a sub- award from the American College of Obstetricians and Gynecologists under Grant #UC4MC28042 from the Health Resources and Services Administration. The views expressed in the written materials and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Resource Acknowledgement Information presented in this module is directly resourced from the 2020 ICD-10-CM/PCS Official Guidelines for Coding and Reporting found on the Centers for Disease Control and Prevention website and the ICD-10-CM and ICD-10-PCS Coding Handbook With Answers published by the American Hospital Association. Our Faculty Carole Liebner, RHIT, CDIP, CCS AHIMA APPROVED ICD-10-CM/PCS TRAINER AHIMA APPROVED REVENUE CYCLE TRAINER Director, Education & Program Development Amber Owens, RHIA, CICA, CCS Director of Health Information Services Program III: Module 3 Topics Review delivery and the procedures assisting delivery. Take a look at manually assisted delivery. Describe C-section delivery. Illustrate vacuum assisted and forceps deliveries. Demonstrate perineal lacerations and episiotomies. And a little assessment at the end to test your knowledge. Delivery Delivery: Assisting the passage of the products of conception from the genital tract. Classified to the Obstetrics Section: Root operation: Delivery Body system: Pregnancy 10E0XZZ: Delivery of products of conception, external approach C-Section Surgical delivery performed when vaginal delivery is not possible or advisable.
    [Show full text]
  • Global Maternity & Multiple Births Billing Guidelines
    Global Maternity & Multiple Births Billing Guidelines Quick Reference Guide Global Maternity Global maternity care includes pregnancy-related antepartum care, admission to labor and delivery, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care until six weeks postpartum. A global charge should be billed for maternity claims when all maternity-related services, as outlined in Blue Cross and Blue Shield of North Carolina’s (BCBSNC’s) corporate medical policy “Guidelines for Global Maternity Reimbursement,” are provided by the same physician or physicians practicing at the same location. The number of antepartum visits may vary from patient to patient. If global maternity care is provided, all maternity related visits and delivery should be billed under the global maternity code. Individual E&M codes should not be billed to report maternity-related E&M visits. Prenatal care is considered an integral part of the global reimbursement and will not be paid separately The Current Procedural Terminology® (CPT) manual identifies the following CPT codes as global maternity services: 59400 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartu m care 59510 - Routine obstetric care including antepartum care, cesarean delivery and postpartum care 59610 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartu m care, after previous cesarean delivery 59618 - Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal deliver y after previous cesarean delivery Billing tips: An initial visit, confirming the pregnancy, is not a part of global maternity care services (verification of benefits will determine appropriate member liability).
    [Show full text]
  • Maternity Care Performance Measurement Set
    American Congress of Obstetricians and Gynecologists National Committee for Quality Assurance Physician Consortium for Performance Improvement® Maternity Care Performance Measurement Set PCPI Approved: March 27th, 2012 Table of Contents Background Page Maternity Care Work Group Member List 4 Purpose of Measurement Set 5-6 Maternity Care Outcomes 6 Intended Audience, Care Setting, and Patient Population 6 Importance of Topic 6-8 Retired Measures 8 Maternity Care Work Group Recommendations 9 Clinical Evidence Base 10 Measure Harmonization 10 Other Potential Measures 10 Technical Specifications Overview 11 Measure Exceptions Overview 11-12 Background on Testing and Implementation of the Measurement Set 12 Diagram Linking Processes to Outcomes 13 Prenatal Measures Measure #1: Establishment of Gestational Age 15-16 Measure #2: Prenatal Care Screening 17-20 Measure #3: Behavioral Health Risk Assessment 21-25 Measures #4: BMI Assessment and Recommended Weight Gain 26-28 Labor and Delivery Measures Measure #5: Elective Delivery Before 39 Weeks 29-33 Measure #6: Cesarean Delivery for Low-Risk Nulliparous Women 33-35 Measure #7: Episiotomy 36-37 Measure #8: Spontaneous Labor and Birth 38-40 Measure #9: Care Coordination: Prenatal Record Present at time of Delivery 41-42 Post-Partum Measure Measure #10: Post-Partum Follow-up for Depression , Breast Feeding, Glucose Screening for 43-45 Gestational Diabetes, and Contraceptive Planning Additional Information Evidence/Classification Rating Schemes of Guideline Developers 46-48 Summary of Non-Material Interest Disclosures 49 References 50-53 Technical Specifications Documents Appendix A Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) convened Physician Consortium for Performance Improvement® (PCPI™) and the National Committee for Quality Assurance (NCQA).
    [Show full text]
  • FY 2009 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2008
    FY 2009 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2008 Tabular 00.3 Computer assisted surgery [CAS] Add inclusion term That without the use of robotic(s) technology Add exclusion term Excludes: robotic assisted procedures (17.41-17.49) New code 00.49 SuperSaturated oxygen therapy Aqueous oxygen (AO) therapy SSO2 SuperOxygenation infusion therapy Code also any: injection or infusion of thrombolytic agent (99.10) insertion of coronary artery stent(s) (36.06-36.07) intracoronary artery thrombolytic infusion (36.04) number of vascular stents inserted (00.45-00.48) number of vessels treated (00.40-00.43) open chest coronary artery angioplasty (36.03) other removal of coronary obstruction (36.09) percutaneous transluminal coronary angioplasty [PTCA] (00.66) procedure on vessel bifurcation (00.44) Excludes: other oxygen enrichment (93.96) other perfusion (39.97) New Code 00.58 Insertion of intra-aneurysm sac pressure monitoring device (intraoperative) Insertion of pressure sensor during endovascular repair of abdominal or thoracic aortic aneurysm(s) New code 00.59 Intravascular pressure measurement of coronary arteries Includes: fractional flow reserve (FFR) Code also any synchronous diagnostic or therapeutic procedures Excludes: intravascular pressure measurement of intrathoracic arteries (00.67) 00.66 Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy Add code also note Code also any: SuperSaturated oxygen therapy (00.49) 1 New code 00.67 Intravascular pressure measurement of intrathoracic
    [Show full text]
  • Episiotomy Scar Endometriosis Diagnosed on Cytology - a Case Report
    www.jbcrs.org Research Article Episiotomy Scar Endometriosis Diagnosed on Cytology - A Case Report Dnyanada Kokode*, Anne Wilkinson, Sadhana Mahore and Trupti Dongre Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur-440019, India Received date: June 11, 2016; Accepted date: June 20, 2017; Published date: June 30, 2017 ABSTRACT Endometriosis, the presence of functioning endometrial tissue outside the uterus, is a common gynaecological condition. Perineal endometriosis is a rare disease characterized by the presence of ectopic endometrial stroma and glands in the perineum. Most commonly observed in the episiotomy scar after normal vaginal deliveries, perineal endometriosis is not often considered in the differential diagnosis of perineal masses. This could lead to unnecessary investigations and inadequate patient treatments. Scar endometriosis is an infrequent type of extrapelvic endometriosis. Scar endometriosis can be a diagnostic challenge in Fine needle aspiration cytology (FNAC) smears that at times, is the first diagnostic modality in some cases. The challenge is amplified when the clinical details are limited and cytopathological features reveal nuclear atypia. Keywords: Scar endometriosis, Perineal endometriosis, Differential diagnosis, Anisonucleosis INTRODUCTION advised FNAC of the nodule which revealed clusters of round epithelial cells with round nuclei and moderate Endometriosis is defined as the presence of cytoplasm. Anisonucleosis was seen in few clusters with endometrial tissue apart from its usual location. It is the occasional macrophages, which were suggestive of second most prevalent benign gynecologic disease after endometriosis [Figure 2]. The scar with the nodule was the presence of fibroids in women of childbearing age excised and sent for histopathology. We received an [1,2].
    [Show full text]
  • Development of the ICD-10 Procedure Coding System (ICD-10-PCS)
    Development of the ICD-10 Procedure Coding System (ICD-10-PCS) Richard F. Averill, M.S., Robert L. Mullin, M.D., Barbara A. Steinbeck, RHIT, Norbert I. Goldfield, M.D, Thelma M. Grant, RHIA, Rhonda R. Butler, CCS, CCS-P The International Classification of Diseases 10th Revision Procedure Coding System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision (ICD-9-CM). The development of ICD-10-PCS was funded by the U.S. Centers for Medicare and Medicaid Services (CMS).1 ICD-10- PCS has a multiaxial seven character alphanumeric code structure that provides a unique code for all substantially different procedures, and allows new procedures to be easily incorporated as new codes. ICD10-PCS was under development for over five years. The initial draft was formally tested and evaluated by an independent contractor; the final version was released in the Spring of 1998, with annual updates since the final release. The design, development and testing of ICD-10-PCS are discussed. Introduction Volume 3 of the International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) has been used in the U.S. for the reporting of inpatient pro- cedures since 1979. The structure of Volume 3 of ICD-9-CM has not allowed new procedures associated with rapidly changing technology to be effectively incorporated as new codes. As a result, in 1992 the U.S. Centers for Medicare and Medicaid Services (CMS) funded a project to design a replacement for Volume 3 of ICD-9-CM.
    [Show full text]