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Posted By Mary Peabody on 06-23-2020, 15:54:38 in Ob-Gyn
Hello Melanie

Would you report a D & E at 22 weeks with 59841-22, 76998?

mo-di twins @ 22w6d
2) stage III twin to twin transfusion syndrome
3) vasa previa

PROCEDURE: The patient was taken to the OR with IV running and anesthesia was administered. She was placed in the dorsal lithotomy position. She was prepped and draped. An open-sided speculum was placed in the vagina and 9 cervical dilators were removed. The cervix was cleaned with betadine. An atraumatic tenaculum was placed on the anterior lip of the cervix. Abdominal ultrasound was placed and continued throughout the procedure. Dilation was assessed and found to be adequate with the Bierer forceps. A 14 mm suction cannula was advanced and the amniotic fluid removed. Bierer forceps were used to transect the umbilical cord and evacuate fragmented fetal parts and placenta. A 7 mm suction cannula was used to confirm an empty uterine cavity and suction aspiration was repeated. A slow trickle of blood was initially noted from the external os, and methergine 0.2 mg IM was given. Good hemostasis was then noted. All instruments were removed from the vagina and the patient was taken to the post-anesthesia recovery room awake and in stable condition. Products of conception were examined and noted to be complete.
 
INTRAOPERATIVE SONO: Indication for intraoperative sono: D&E performed with forceps. Realtime ultrasound guidance was performed transabdominallly during the procedure. No evidence of uterine or cervical trauma or complications noted. Empty uterine cavity after the procedure.
Comments (1)
Posted By Melanie Witt on 06-29-2020, 15:23:36
Yes. ACOG also has made this recommendation.
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