CPT® Code 59870

1. Indications

The procedure of uterine evacuation and curettage for hydatidiform mole is indicated for the following conditions:

• Hydatidiform Mole - This procedure is performed when a patient is diagnosed with a complete or partial molar pregnancy, which involves abnormal growth of placental tissue.
• Retained Products of Conception - It may also be indicated if there are retained products of conception following a miscarriage or abortion, particularly when there is a risk of complications.

2. Procedure

The procedure of uterine evacuation and curettage for hydatidiform mole involves several critical steps to ensure effective removal of the abnormal tissue:

• Preparation of the Cervix - The cervix is first exposed and cleansed with an antiseptic solution to minimize the risk of infection during the procedure.
• Grasping the Cervix - The anterior cervical lip is then grasped using a tenaculum, a surgical instrument that helps stabilize the cervix for further manipulation.
• Determining Uterine Depth - A sound is passed through the cervix to ascertain the depth and angle of the uterus, which is crucial for the subsequent steps of the procedure.
• Dilation of the Cervix - The cervix is numbed and dilated by introducing a series of metal rods of increasing diameter into the cervical canal. Alternatively, a laminaria tent may be inserted into the cervix 8-20 hours prior to the procedure. The laminaria absorbs moisture and swells, gradually dilating the cervical canal.
• Evacuation of Molar Tissue - A curette is then inserted through the cervix to scrape the uterine wall, or a suction curette may be used. In the suction method, suction is initiated while the curette is rotated in a full circle several times to ensure complete removal of tissue. The procedure is considered complete when tissue and blood cease to pass through the curette.
• Pathology Examination - The evacuated tissue is sent for pathology examination to confirm the diagnosis and assess any further treatment needs.
• Post-Procedure Care - After the procedure, the tenaculum is removed, and any bleeding from the cervix is controlled through the application of pressure.

3. Post-Procedure

Post-procedure care following uterine evacuation and curettage for hydatidiform mole includes monitoring for any signs of complications such as excessive bleeding or infection. Patients are typically advised to rest and may be prescribed medications to manage pain or discomfort. Follow-up appointments are essential to ensure proper recovery and to discuss the results of the pathology examination. Patients should also be counseled regarding future pregnancies, as there may be specific recommendations based on the findings from the procedure.