CPT® Code 59850

1. Indications

The procedure of induced abortion by intra-amniotic injections is indicated for the following conditions:

• Second Trimester Pregnancy This procedure is specifically reserved for patients who are in the second trimester of pregnancy, where other methods may not be applicable or effective.
• Medical Necessity Indications may include situations where the continuation of the pregnancy poses a risk to the health of the mother or fetus, although specific medical necessity criteria are not detailed in the provided data.

2. Procedure

The procedure for an induced abortion using intra-amniotic injections involves several critical steps to ensure safety and effectiveness:

• Cervical Preparation Prior to the procedure, cervical preparation is performed, which may include the insertion of laminaria, prostaglandin, or other cervical dilators into the cervix. This step is typically done eight to twenty-four hours before the planned abortion to facilitate adequate cervical dilation.
• Ultrasound Guidance Once the cervix is confirmed to be dilated, the abdomen is cleansed, and an ultrasound is used to identify a pocket of amniotic fluid. This step is crucial for accurately placing the needle for the injection.
• Needle Insertion A needle is then inserted into the identified pocket of amniotic fluid. In some cases, a local anesthetic may be administered at the planned puncture site to minimize discomfort for the patient.
• Injection of Agents After confirming the free flow of amniotic fluid, a cannula is inserted through the needle, which is then withdrawn.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 of uterine and fetal activity, as well as the mother's vital signs, is conducted throughout this process.
• Additional Injections If necessary, additional intra-amniotic injections may be performed to ensure the effectiveness of the procedure.
• Delivery of Fetus and Placenta The fetus and placenta are delivered vaginally. Following delivery, the products of conception are inspected to verify that the abortion is complete.
• Management of Incomplete Abortion If an incomplete abortion occurs, 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 using a tenaculum to grasp the anterior cervical lip. 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 patient safety and comfort.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications, including excessive bleeding or signs of infection. The healthcare provider will ensure that the patient is stable and may provide instructions for follow-up care. It is essential to verify that the abortion is complete, and if any tissue remains, further intervention such as dilation and curettage may be necessary. Patients are typically advised on what to expect during recovery and when to seek medical attention if complications arise.