CPT® Code 59851

1. Indications

The procedure is indicated for the following conditions:

• Second Trimester Pregnancy Termination Indicated for patients seeking to terminate a pregnancy during the second trimester.

2. Procedure

The procedure involves several critical steps to ensure its effectiveness and safety:

• Cervical Preparation Eight to 24 hours prior to the induced abortion, cervical preparation is performed. This may include the insertion of laminaria, prostaglandin, or other cervical dilators to facilitate the dilation of the cervix, making the subsequent procedure easier and safer.
• Ultrasound and Amniotic Fluid Identification Following cervical preparation, the abdomen is cleansed, and an ultrasound is conducted to identify a pocket of amniotic fluid. This step is crucial for the accurate placement of the needle.
• Needle Insertion A local anesthetic may be administered at the planned puncture site. A spinal needle is then introduced into the amniotic sac, and free flow of amniotic fluid is confirmed to ensure proper placement.
• Intra-Amniotic Injection Once the needle is correctly positioned, a cannula is inserted through the needle, which is then withdrawn. The first intra-amniotic injection is performed, which is intended to cause fetal demise and induce labor.
• Monitoring Throughout the procedure, uterine and fetal activity is closely monitored, along with the vital signs of the mother, to ensure safety and effectiveness.
• Additional Injections If necessary, additional intra-amniotic injections may be performed to assist in the termination process.
• Delivery of Fetus and Placenta The fetus and placenta are delivered vaginally. After delivery, the products of conception are inspected to verify that the abortion is complete.
• Dilation and Curettage (if needed) In cases of incomplete abortion, a dilation and curettage or evacuation is performed. This involves placing a speculum in the vagina to expose the cervix, cleansing it with an antiseptic solution, and grasping the anterior cervical lip with a tenaculum. A sound is passed to determine the depth and angle of the uterus, followed by the insertion of a curette through the cervix to scrape or suction the uterine wall. The tissue obtained is sent for pathology examination.
• Post-Procedure Care After the procedure, the tenaculum is removed, and any bleeding from the cervix is controlled with pressure to ensure the patient's safety and comfort.

3. Post-Procedure

Post-procedure care includes monitoring the patient for any complications, managing pain, and ensuring that any bleeding is controlled. Patients may require follow-up visits to confirm the completeness of the abortion and to address any potential complications. It is essential to provide appropriate counseling and support during the recovery process.