My patient had C-Section in afternoon and then in evening she returned to OR for the D/c under ultrasound guidance with placement of Bakri uterine ballon. Would 59899-78 and compare it to 43460 for Baki Balloon. Then for D/C under ultrasound guidance 59160 with 76986.
Diagnosis
Postpartum hemorrhage
Procedures
Dilation and curettage under ultrasound guidance with placement of Bakri uterine balloon
Indications: surgery for postpartum hemorrhage
Procedure Details:
A weighted speculum was placed in the vagina and clots were suctioned to view the cervix. The anterior lip the cervix was grasped with a ring forcep. Clots were evacuated from the vagina and lower uterine segment using suction device. At this time a sharp banjo curette used circumferentially in the uterine cavity to remove blood products. There was suspicion of possibly a retained portion of placenta in the left cornual region, the tissue obtained will be sent for pathology confirmation. Additionally a suction D&C was performed with a 14 French curved curette. Next a Bakri balloon was placed at the fundus under ultrasound guidance and the first attempt of filling was unsuccessful due to a kink. This was removed and replaced again confirmed in the correct position and filling was successful. The Bakley balloon was fillled up to 500 cc of normal saline. At this time bleeding was vastly improved. Patient did receive 1 bag of hespan, 1 L of albumin with another starting, and is additionally on a phenylephrine drip. All instrument and sponge counts were accounted for. Anesthesia felt she was stable for extubation transport to ICU.
While in the OR I called personally Dr from the CCU team and notified him of the patient's information and current status. Additionally a Jehovah's Witness liaison has been notified and will be meeting the patient in the ICU.
After the surgical case I spoke directly with all family members with a Spanish translator present. I discussed the loss of blood after her cesarean, the performed procedure, and the blood loss during the procedure. I have made them fully aware there is always a possibility of additional procedures and surgeries that may need to be performed for lifesaving measures. I have answered all their questions at this time
Diagnosis
Postpartum hemorrhage
Procedures
Dilation and curettage under ultrasound guidance with placement of Bakri uterine balloon
Indications: surgery for postpartum hemorrhage
Procedure Details:
A weighted speculum was placed in the vagina and clots were suctioned to view the cervix. The anterior lip the cervix was grasped with a ring forcep. Clots were evacuated from the vagina and lower uterine segment using suction device. At this time a sharp banjo curette used circumferentially in the uterine cavity to remove blood products. There was suspicion of possibly a retained portion of placenta in the left cornual region, the tissue obtained will be sent for pathology confirmation. Additionally a suction D&C was performed with a 14 French curved curette. Next a Bakri balloon was placed at the fundus under ultrasound guidance and the first attempt of filling was unsuccessful due to a kink. This was removed and replaced again confirmed in the correct position and filling was successful. The Bakley balloon was fillled up to 500 cc of normal saline. At this time bleeding was vastly improved. Patient did receive 1 bag of hespan, 1 L of albumin with another starting, and is additionally on a phenylephrine drip. All instrument and sponge counts were accounted for. Anesthesia felt she was stable for extubation transport to ICU.
While in the OR I called personally Dr from the CCU team and notified him of the patient's information and current status. Additionally a Jehovah's Witness liaison has been notified and will be meeting the patient in the ICU.
After the surgical case I spoke directly with all family members with a Spanish translator present. I discussed the loss of blood after her cesarean, the performed procedure, and the blood loss during the procedure. I have made them fully aware there is always a possibility of additional procedures and surgeries that may need to be performed for lifesaving measures. I have answered all their questions at this time