Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM...
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Transcript of Copyright © 2012 by Mosby, an imprint of Elsevier Inc. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM...
Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM
Chapter Seven
2Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
gravid/o, -gravida, -cyesis = pregnancy
nulli- = none
primi- = first
multi- = many
Anatomy and Physiology of Pregnancy
ConceptionCoitus/copulationGestation
Gravida Nulligravida Primigravida Multigravida
3Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
CM Guideline Alert
15.a. General Rules for Obstetric Cases 1) Codes from Chapter 15 and sequencing priority
Obstetric cases require codes from Chapter 15, codes in the range O00-09a, Pregnancy, Childbirth, and the Puerperium. Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with Chapter 15 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any Chapter 15 codes. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy.
2) Chapter 15 Codes used only on the maternal record Chapter 15 codes are to be used only on the maternal record,
never on the record of the newborn.
4Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Time Periods of Pregnancy
Normal Length EDD LMP
Trimesters
5Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
CM Guideline Alert
15.a.3 Final Character for Trimester The majority of codes in Chapter 15 have a final character
indicating the trimester of pregnancy. The timeframes for the trimesters are indicated at the beginning of the chapter. If trimester is not a component of a code it is because the condition always occurs in a specific trimester, or the concept of trimester of pregnancy is not applicable. Certain codes have characters for only certain trimesters because the condition does not occur in all trimesters, but it may occur in more than just one.
Assignment of the final character for trimester should be based on the providers documentation of the trimester (or number of weeks) for the current admission/encounter. This applies to the assignment of trimester for pre-existing conditions as well as those that develop during or are due to the pregnancy. The provider’s documentation of the number of weeks of pregnancy may be used to assign the appropriate code identifying the trimester.
Whenever delivery occurs during the current admission, and there is an “in childbirth” option for the obstetric complication being coded, the “in childbirth” code should be assigned.
6Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
blast/o = embryonic, immature
-cyst = sac
troph/o = development, nourishment
-blast = embryonic, immature
Anatomy of PregnancyZygoteMorulaBlastocyst
Implantation hCG Trophoblast
7Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
mono- = one
chorion/o = chorion, outer fetal sac
-ic = pertaining to
di- = two
amni/o = amnion, outer fetal sac
-tic = pertaining to
Anatomy of PregnancyTwins
Monozygotic Dizygotic Dichorionic/diamniotic Monochorionic/diamniotic Monochorionic/monoamniotic Conjoined twins
8Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Review Question
A woman who is a nulligravida:A. has never been pregnantB. has been pregnant onceC. has been pregnant two or more times
9Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
fet/o = fetus
post- = after
Anatomical Development and Trimesters
Zygote 3 weeks
Embryo 3-8 weeks
Fetus >8 weeks Trimester development Term pregnancy Post-term
40-42 weeks Prolonged pregnancy
>42 weeks
10Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
extra- = outside
chori/o, chorion/o =
chorion
placent/o = placenta
amni/o = amnion
umbilic/o, omphal/o = umbilicucs
Extraembryonic MembranesAmnion
Amniotic fluid Allantois Umbilical cord
Chorion Placenta Chorionic villi
Uterus of a pregnant woman
11Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Signs of Pregnancy
12Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
part/o , -para, -partum = parturition, delivery
ante- = before
intra- = within
nulli- = none
primi- = first
multi- = many
Delivery and ChildbirthParturition
Antepartum Intrapartum Postpartum
Parity Nullipara Primipara
Young Elderly
Multipara Grand multiparity
Puerperium
13Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
CM Guideline Alert
15.0. The Peripartum and Postpartum Period1) Peripartum and postpartum periods
The postpartum period begins immediately after delivery and continues for 6 weeks following delivery. The peripartum period is defined as the last month of pregnancy to 5 months postpartum.
2) Peripartum and postpartum complications A postpartum complication is any complication occurring within the
6-week period.
3) pregnancy-related complications after 6-week periodChapter 15 codes may also be used to describe pregnancy –
related complications after the peripartum or postpartum period if the provider documents that a condition is pregnancy related.
14Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Review Question
The 6-week time period after a delivery is termed:
A. parturitionB. puerperiumC. gestationD. copulation
15Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
-tocia = labor
Stages of LaborFirst
Early/latent Active Transitional
SecondThird
16Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
neo- = new
nat/o = birth
pre- = before
ante- = before
peri- = around
post- = after
BirthNat/o
Neonate Prenatal/antenatal Perinatal Postnatal
17Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Newborn Weights and Length of Gestation Terminology
Extremely low birth weightExtreme immaturityOther immaturityLate newborn, not heavy for gestational ageProlonged gestationExceptionally large newbornHeavy for gestational ageLight for gestational age (LGA) vs. small for
gestational age (SMA)
Be Careful! LGA is an abbreviation that has in the past meant “large for gestational age” but which now means “light for gestational age.”
18Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
CM Guideline Alert
16.d. Prematurity and Fetal Growth Retardation Providers utilize different criteria in determining
prematurity. A code for prematurity should not be assigned unless it is documented. Assignment of codes in categories P05, Disorders of newborn related to slow fetal growth and fetal malnutrition, and P07, Disorders of newborn related to short gestation and low birth weight, not elsewhere classified, should be based on the recorded birth weight and estimated gestational age. Codes from category P05 should not be assigned with codes from category P07.
19Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
CM Guideline Alert
16.e. Low Birth Weight and Immaturity Status Codes from category P07, disorders of newborn
related to short gestation and low birth weight, not elsewhere classified, are for use for a child or adult who was premature or had a low birth weight as a newborn and this is affecting the patient’s current health status.
20Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Special Note
When both birth weight and gestational age of the newborn are available, both should be coded with birth weight sequenced before gestational age.
21Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
APGAR Score
A: appearanceP: pulseG: grimaceA: activityR: respiration
22Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Be Careful!
LGA is an abbreviation that has in the past been used to mean “large for gestational age” but which now means “light for gestational age.”
23Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Review Question
Birth takes place during which stage of labor?
A.FirstB.SecondC.ThirdD.Fourth
24Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
ec- = out
top/o = place
-ic = pertaining to
hydatid/i = water drop
-form = shape
Pregnancy with Abortive Outcome (O00-O08)Ectopic pregnancyHydatidiform moleMiscarriage/abortion
Spontaneous vs. therapeutic Missed Incomplete
Ectopic pregnancy
25Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
CM Guideline Alert
16.g. Stillbirth Code P95, Stillbirth, is only for use in institutions that
maintain separate records for stillbirths. No other code should be used with P95. code P95 should not be used on the mother’s record.
26Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
-edema = swelling
hem/o = blood
-lysis = breaking down
pre- = before
Edema, Proteinuria, and Hypertensive Disorders in Pregnancy, Childbirth, and the Puerperium (O10-O16)Eclampsia in pregnancyGestational edemaHELLP syndrome
Hemolysis, elevated liver enzymes, low platelet count
Preeclampsia
27Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
phleb/o = vein
-it is = inflammation
hyper- = excessive
-emesis = vomiting
gravidarum = pregnancy
prurit/o = itching
Other Maternal Disorders Predominately Related to Pregnancy (O20-)29)Gestational phlebitisHyperemesis gravidarumPUPP
Pruritic urticarial papules and plaques
28Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Review Question
Which of the following terms describes a pregnancy that is “out of its (normal) place”?
A. HELLPB. PUPPC. eclampsiaD. ectopic pregnancy
29Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
cephal/o = head
pelv/i = pelvis
-ic = pertaining to
cervic/o = cervix
-al = pertaining to
mal- = bad, abnormal
The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)Cephalopelvic disproportionCervical incompetenceMalpresentation of fetus
Malpresentation of fetus
30Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)
Abruptio placentae
31Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word parts
erythr/o = red (blood cell)
blast/o = immature
-osis = abnormal
condition
The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)Twin-to-twin transfusion syndrome (TTTS)Erythroblastosis fetalis
Erythroblastosis fetalis
32Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
olig/o = scanty
hydr/o = water, fluid
-amnios = amnion
poly- = excessive
chori/o = chorion
amnion/o = amnion
-itis = inflammation
The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)OligohydramniosPolyhydramniosChorioamnionitis
33Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
placent/o = placenta
-it is = inflammation
previa = in front of
ac- = toward
cret/o = to grow
-a = noun ending
per- = through
in- = in
The Fetus and Amniotic Cavity and Possible Delivery Problems (O30-O48)PlacentitisPlacenta previaPlacenta accretaPlacenta incretaPlacenta percreta
34Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
nuch/o = neck
-al = pertaining to
dys- = abnormal, difficult
-tocia = labor, childbirth
Complications of Labor and Delivery (O60—O77)Nuchal cordDystocia
Meconium staining
35Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
a- = without
galact/o = milk
-ia = condition
-rrhea = flow, discharge
hypo- = deficient, below
puerper/o = puerperium
-al = pertaining to
sepsis = infection
Complications Predominantly Related to the Puerperium (O85-O92)AgalactiaGalactorrheaHypogalactiaPuerperal sepsis
36Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
CM Guideline Alert
15.k. Puerperal Sepsis Code O85, Puerperal sepsis, should be assigned with a
secondary code to identify the causal organism (e.g. for a bacterial infection, assign a code from category B95-B97, Bacterial infections in conditions classified elsewhere). A code from category A40, Streptococcal sepsis, or A41, Other sepsis, should not be used for puerperal sepsis. If applicable , use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction. Needs additional code for causal organism.
37Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
chori/o = chorion
-carcinoma = cancer of epithelial
origin
Malignant Neoplasms (C58)Choriocarcinoma
38Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Review Question
Which term describes a condition of deficient amniotic fluid?
A. chorioamnionitisB. oligohydramniosC. polyhydramniosD. erythroblastosis fetalis
39Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Prenatal Diagnosis
Alpha fetoprotein (AFP) testContraction stress test (CST)Nonstress test (NST)Pregnancy test
40Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
amni/o = amnion
-centesis = surgical puncture
chorion/o = chorion
pelv/i = pelvis
-metry = measuring
Prenatal DiagnosisAmniocentesisChorionic villus sampling (CVS)Pelvimetry
Amniocentesis
41Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Pregnancy and Delivery
Cerclage
42Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Pregnancy and Delivery
Cesarean section (C-section, CS)
43Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
cephal/o = head
-ic = pertaining to
version = turning
episi/o = vulva
-tomy = cutting
vagin/o = vagina
-al = pertaining to
Pregnancy and Delivery ProceduresCephalic versionEpisiotomyVBAC (vaginal birth after C-section)Vaginal delivery
Presentation Assistance PCS:
delivery = extractionEpisiotomy
44Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
PCS Guideline Alert
C1 Procedures performed on products of conception are
coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Medical and Surgical section.
45Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
PCS Guideline Alert
C2 Procedures performed following a delivery or abortion
for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained. Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium.
46Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Suffixes and Root Operations for Pregnancy, Childbirth, and the Puerperium
47Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Review Question
Which term describes a procedure to turn the head of the fetus towards the cervical outlet for a vaginal delivery?
A. CSB. cerclageC. cephalic versionD. CVS
48Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Sort these terms into their correct categories
Terms1. chorioamnionitis2. agalactia3. cerclage4. amniocentesis5. parturition
Categories__ A + P__ Pathology__ Procedures