NTSV: Accurate Coding for Improved Quality Measures Program III: OB Procedure Coding Module 3: Delivery and Procedures Assisting Delivery Grant Acknowledgement
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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. -
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....................................................................................................................... -
Mid-Trimester Preterm Premature Rupture of Membranes (PPROM): Etiology, Diagnosis, Classification, International Recommendations of Treatment Options and Outcome
J. Perinat. Med. 2018; 46(5): 465–488 Review article Open Access Michael Tchirikov*, Natalia Schlabritz-Loutsevitch, James Maher, Jörg Buchmann, Yuri Naberezhnev, Andreas S. Winarno and Gregor Seliger Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome DOI 10.1515/jpm-2017-0027 neonates delivered without antecedent PPROM. The “high Received January 23, 2017. Accepted May 19, 2017. Previously pub- PPROM” syndrome is defined as a defect of the chorio- lished online July 15, 2017. amniotic membranes, which is not located over the inter- nal cervical os. It may be associated with either a normal Abstract: Mid-trimester preterm premature rupture of mem- or reduced amount of amniotic fluid. It may explain why branes (PPROM), defined as rupture of fetal membranes sensitive biochemical tests such as the Amniosure (PAMG-1) prior to 28 weeks of gestation, complicates approximately or IGFBP-1/alpha fetoprotein test can have a positive result 0.4%–0.7% of all pregnancies. This condition is associ- without other signs of overt ROM such as fluid leakage with ated with a very high neonatal mortality rate as well as an Valsalva. The membrane defect following fetoscopy also increased risk of long- and short-term severe neonatal mor- fulfils the criteria for “high PPROM” syndrome. In some bidity. The causes of the mid-trimester PPROM are multi- cases, the rupture of only one membrane – either the cho- factorial. Altered membrane morphology including marked rionic or amniotic membrane, resulting in “pre-PPROM” swelling and disruption of the collagen network which is could precede “classic PPROM” or “high PPROM”. -
Amnioinfusion in the Etiological Diagnosis and Therapeutics Of
14th World Congress in Fetal Medicine Amnioinfusion in the etiological diagnosis and therapeutics of oligohydramnios: 17 years of experience Borges-Costa S, Bernardo A, Santos A Prenatal Diagnosis Center, Hospital Garcia de Orta, Almada, Portugal Objective To review the maternal and fetal outcomes of all amnioinfusions performed for the diagnosis and treatment of oligohydramnios during pregnancy (excluding labor). Methods This is a retrospective study of 31 singleton pregnancies with oligohydramnios in the second and third trimesters which underwent transabdominal amnioinfusion between December/1997 and December/2014 in the Prenatal Diagnosis Center at the Hospital Garcia de Orta. The gestational age ranged from 15 weeks and 5 days to 32 weeks and 2 days (average 22 weeks). The initial amniotic fluid index ranged from 0 to 6, 5 cm. The procedure was done only by trained professionals. Under ultrasound guidance, isotonic fluid, such as normal saline or Ringer's lactate, is infused into the amniotic cavity via a 20 G needle inserted through the uterine wall. The volume infused ranged from 100 to 800cc (average 380cc). A genetic study was conducted in 29 cases (93, 5%), performed after amniocentesis (26 cases) or cordocentesis (3 cases). In all cases, there was an exhaustive study of the fetal anatomy after the amnioinfusion. In this study the following parameters were evaluated: maternal characteristics (age, personal and obstetrical history), evolution of pregnancy, perinatal mortality and maternal complications. Histopathological examinations -
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. -
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. -
Therapeutic Amnioinfusion in Oligohydramnios During Pregnancy (Excluding Labor)
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Qazi M et al. Int J Reprod Contracept Obstet Gynecol. 2017 Oct;6(10):4577-4582 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174445 Original Research Article Therapeutic amnioinfusion in oligohydramnios during pregnancy (excluding labor) Mahvish Qazi1, Najmus Saqib2*, Abida Ahmed1, Imran Wagay3 1Department of Obstetrics and Gynecology, SKIMS Soura Srinagar Kashmir, India 2Department of Paediatrics and Neonatology, Government Medical College Jammu, Jammu and Kashmir, India 3Department of Radiodiagnosis, Govt. Medical College Srinagar, Jammu and Kashmir, India Received: 05 August 2017 Accepted: 04 September 2017 *Correspondence: Dr. Najmus Saqib, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Oligohydramnios is a serious complication of pregnancy that is associated with a poor perinatal outcome and complicates 1-5% of pregnancies. The purpose of this study was to evaluate the role of antepartum transabdominal amnioinfusion on amniotic fluid volume/latency period in pregnancies with oligohydramnios. Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Sher-i-Kashmir Institute of Medical Sciences Soura Srinagar. In this study, a total of 54 pregnant women with ultrasonographically diagnosed oligohydramnios i.e. AFI < 5 cm and gestational age of >24 weeks were taken for therapeutic amnioinfusion and its effects on amniotic fluid volume were studied. -
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. -
• 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 -
Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A
Jacob et al. Obstet Gynecol cases Rev 2015, 2:5 ISSN: 2377-9004 Obstetrics and Gynaecology Cases - Reviews Case Report: Open Access Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A. Jacob1, Norman A. Ginsberg2, Lee P. Shulman2* and Leeber Cohen2 1Albert-Ludwigs-University School of Medicine, Germany 2Northwestern Feinberg School of Medicine, USA *Corresponding author: Prof. Lee P. Shulman MD, 250 E. Superior Street, Prentice Women’s Hospital, Room 05- 2174, Chicago, IL, USA 60611, Tel: 1.312.730.8694, Email: [email protected] weeks‘gestation with an AFI of 1cm. The patient reported no history Abstract of vaginal amniotic fluid leakage. Speculum examination showed Idiopathic severe preterm oligohydamnios as a result of spontaneous no evidence of vaginal pooling. The fetal kidneys were visualized at rupture of the amnion with an intact chorion is a rare event with a the time of the ultrasound and were considered functioning since scarcity of reports found in the literature. We evaluated the impact the fetal bladder was visualized at the time of ultrasound. Chorionic of serial amnioinfusions on this unusual occurrence. This is a follow- villus sampling (CVS) was performed after the 18-week scan and up of a 37-year-old woman with idiopathic severe oligohydramnios diagnosed at 18 weeks of gestation. We performed five serial showed a normal 46,XX complement. amnioinfusions with the purpose of improving fetal lung maturity The patient was informed of the complications accompanied and to prevent Potter anomalad. At 31 weeks‘gestation the patient with oligohydramnios and was offered pregnancy termination. -
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. -
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).