CPT® Code 59618

1. Indications

The procedure described by CPT® Code 59618 is indicated for patients who have undergone a previous cesarean delivery and are attempting a vaginal delivery but experience a failed trial of labor. The following conditions may warrant this procedure:

• Previous Cesarean Delivery: The patient has a history of cesarean section, which influences the management of the current pregnancy.
• Attempted Vaginal Delivery: The patient is attempting a vaginal delivery, which may be part of a birth plan or patient preference.
• Failed Trial of Labor: The patient experiences complications or failure during the labor process, necessitating a transition to cesarean delivery.

2. Procedure

The procedure involves several critical steps that ensure the safety and health of both the mother and the baby. Each step is outlined as follows:

• Initial Assessment: The physician conducts an initial maternal history and evaluates the health status of both the mother and fetus during routine prenatal visits. This includes monitoring the pregnancy's progress and addressing any concerns.
• Prenatal Visits: The patient attends monthly office visits for the first 28 weeks of gestation, biweekly visits until 36 weeks, and weekly visits thereafter to ensure proper monitoring and care throughout the pregnancy.
• Transfer to Surgical Suite: Upon determining that a vaginal delivery is not feasible, the patient is transferred to the surgical suite for a cesarean delivery. An anesthetic, such as an epidural, is administered to provide pain relief during the procedure.
• Abdominal Incision: The physician makes an incision in the abdomen to access the uterus. This step is crucial for the subsequent delivery of the baby.
• Uterine Incision and Amniotic Fluid Removal: An incision is made in the uterus, and the amniotic fluid is suctioned out to prepare for the delivery of the baby.
• Delivery of the Baby: The physician disengages the baby's head from the pelvis and delivers it through the uterine incision. After the head is delivered, the physician suctions the baby's airways to clear any obstructions.
• Complete Delivery: The baby is fully removed from the uterus, and the physician checks for any complications, such as umbilical cord entanglement, ensuring the baby's safety.
• Post-Delivery Care: The baby is shown to the parents and placed in a warmer for examination and care by other medical staff. The placenta is also removed and examined by the physician.
• Closure of Incisions: The physician closes the uterine incision and the abdominal layers in a layered fashion to promote healing.
• Post-Operative Follow-Up: The physician provides post-cesarean care during the hospital stay and schedules follow-up visits to monitor the mother's recovery.

3. Post-Procedure

After the cesarean delivery, the patient is monitored in the hospital for any complications related to the surgery or recovery. Post-operative care includes pain management, monitoring for signs of infection, and ensuring proper healing of the surgical site. The physician will provide instructions for at-home care and schedule follow-up appointments to assess the patient's recovery progress. It is essential for the patient to attend these follow-up visits to ensure that both her health and the health of the newborn are being adequately managed.