Transcript Pregnancy, Childbirth, and the Puerperium

Chapter Seven
PREGNANCY, CHILDBIRTH, AND THE
PUERPERIUM
Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
Word Parts
gravid/o, -gravida,
-cyesis = pregnancy
nulli- = none
primi- = first
multi- = many
Anatomy and Physiology of
Pregnancy
 Conception
 Coitus/copulation
 Gestation




Gravida
Nulligravida
Primigravida
Multigravida
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CM Guideline Alert
 15.a. General Rules for Obstetric Cases

1) Codes from Chapter 15 and sequencing priority


Obstetric cases require codes from Chapter 15, codes in the range
O00-09a, Pregnancy, Childbirth, and the Puerperium. Chapter 15
codes have sequencing priority over codes from other chapters.
Additional codes from other chapters may be used in conjunction with
Chapter 15 codes to further specify conditions. Should the provider
document that the pregnancy is incidental to the encounter, then code
Z33.1, Pregnant state, incidental, should be used in place of any
Chapter 15 codes. It is the provider’s responsibility to state that the
condition being treated is not affecting the pregnancy.
2) Chapter 15 Codes used only on the maternal record

Chapter 15 codes are to be used only on the maternal record, never on
the record of the newborn.
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Time Periods of Pregnancy
 Normal Length
 EDD
 LMP
 Trimesters
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CM Guideline Alert
 15.a.3 Final Character for Trimester
 The majority of codes in Chapter 15 have a final character indicating the
trimester of pregnancy. The timeframes for the trimesters are indicated
at the beginning of the chapter. If trimester is not a component of a code
it is because the condition always occurs in a specific trimester, or the
concept of trimester of pregnancy is not applicable. Certain codes have
characters for only certain trimesters because the condition does not
occur in all trimesters, but it may occur in more than just one.
 Assignment of the final character for trimester should be based on the
providers documentation of the trimester (or number of weeks) for the
current admission/encounter. This applies to the assignment of
trimester for pre-existing conditions as well as those that develop during
or are due to the pregnancy. The provider’s documentation of the
number of weeks of pregnancy may be used to assign the appropriate
code identifying the trimester.
 Whenever delivery occurs during the current admission, and there is an
“in childbirth” option for the obstetric complication being coded, the “in
childbirth” code should be assigned.
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Word Parts
blast/o = embryonic,
immature
-cyst = sac
troph/o = development,
nourishment
-blast = embryonic,
immature
Anatomy of Pregnancy
 Zygote
 Morula
 Blastocyst



Implantation
hCG
Trophoblast
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Word Parts
Anatomy of Pregnancy
 Twins
mono- = one

chorion/o = chorion,
outer fetal
sac

-ic = pertaining to

di- = two

amni/o = amnion, outer
fetal sac


Monozygotic
Dizygotic
Dichorionic/diamniotic
Monochorionic/diamniotic
Monochorionic/monoamniotic
Conjoined twins
-tic = pertaining to
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Review Question
 A woman who is a nulligravida:
A. has never been pregnant
B. has been pregnant once
C. has been pregnant two or more times
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Word Parts
fet/o = fetus
post- = after
Anatomical Development and
Trimesters
 Zygote

3 weeks
 Embryo

3-8 weeks
 Fetus




>8 weeks
Trimester development
Term pregnancy
Post-term


40-42 weeks
Prolonged pregnancy

>42 weeks
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Word Parts
Extraembryonic Membranes
 Amnion
extra- = outside

chori/o, chorion/o =
chorion

placent/o = placenta
amni/o = amnion
umbilic/o, omphal/o =
umbilicucs

Amniotic fluid
Allantois
Umbilical cord
 Chorion
 Placenta
 Chorionic villi
Uterus of a pregnant woman
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Signs of Pregnancy
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Word Parts
part/o , -para, -partum
= parturition, delivery
ante- = before
intra- = within
nulli- = none
primi- = first
Delivery and Childbirth
 Parturition



Antepartum
Intrapartum
Postpartum
 Parity
 Nullipara
 Primipara
Young
 Elderly

multi- = many


Multipara
Grand multiparity
 Puerperium
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CM Guideline Alert
 15.0. The Peripartum and Postpartum Period
1) Peripartum and postpartum periods
The postpartum period begins immediately after delivery and continues
for 6 weeks following delivery. The peripartum period is defined as the
last month of pregnancy to 5 months postpartum.
2) Peripartum and postpartum complications
A postpartum complication is any complication occurring within the
6-week period.
3) pregnancy-related complications after 6-week period
Chapter 15 codes may also be used to describe pregnancy –related
complications after the peripartum or postpartum period if the
provider documents that a condition is pregnancy related.
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Review Question
 The 6-week time period after a delivery is termed:
A. parturition
B. puerperium
C. gestation
D. copulation
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Word Parts
-tocia = labor
Stages of Labor
 First



Early/latent
Active
Transitional
 Second
 Third
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Word Parts
Birth
 Nat/o
neo- = new

nat/o = birth

pre- = before

ante- = before

Neonate
Prenatal/antenatal
Perinatal
Postnatal
peri- = around
post- = after
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Newborn Weights and Length of Gestation
Terminology
 Extremely low birth weight
 Extreme immaturity
 Other immaturity
 Late newborn, not heavy for gestational age
 Prolonged gestation
 Exceptionally large newborn
 Heavy for gestational age
 Light for gestational age (LGA) vs. small for gestational
age (SMA)
Be Careful! LGA is an abbreviation that has in the past meant “large for
gestational age” but which now means “light for gestational age.”
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CM Guideline Alert
 16.d. Prematurity and Fetal Growth Retardation
 Providers utilize different criteria in determining prematurity.
A code for prematurity should not be assigned unless it is
documented. Assignment of codes in categories P05,
Disorders of newborn related to slow fetal growth and fetal
malnutrition, and P07, Disorders of newborn related to short
gestation and low birth weight, not elsewhere classified, should
be based on the recorded birth weight and estimated
gestational age. Codes from category P05 should not be
assigned with codes from category P07.
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CM Guideline Alert
 16.e. Low Birth Weight and Immaturity Status
 Codes from category P07, disorders of newborn related to
short gestation and low birth weight, not elsewhere classified,
are for use for a child or adult who was premature or had a low
birth weight as a newborn and this is affecting the patient’s
current health status.
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Special Note
 When both birth weight and gestational age of the
newborn are available, both should be coded with
birth weight sequenced before gestational age.
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APGAR Score
 A: appearance
 P: pulse
 G: grimace
 A: activity
 R: respiration
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Be Careful!
 LGA is an abbreviation that has in the past been used
to mean “large for gestational age” but which now
means “light for gestational age.”
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Review Question
 Birth takes place during which stage of labor?
A. First
B. Second
C. Third
D. Fourth
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Word Parts
ec- = out
top/o = place
-ic = pertaining to
hydatid/i = water drop
-form = shape
Pregnancy with Abortive
Outcome (O00-O08)
 Ectopic pregnancy
 Hydatidiform mole
 Miscarriage/abortion



Spontaneous vs. therapeutic
Missed
Incomplete
Ectopic pregnancy
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CM Guideline Alert
 16.g. Stillbirth
 Code P95, Stillbirth, is only for use in institutions that
maintain separate records for stillbirths. No other code should
be used with P95. code P95 should not be used on the
mother’s record.
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Word Parts
-edema = swelling
hem/o = blood
-lysis = breaking down
pre- = before
Edema, Proteinuria, and
Hypertensive Disorders in
Pregnancy, Childbirth, and the
Puerperium (O10-O16)
 Eclampsia in pregnancy
 Gestational edema
 HELLP syndrome

Hemolysis, elevated liver enzymes, low
platelet count
 Preeclampsia
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Word Parts
phleb/o = vein
-it is = inflammation
hyper- = excessive
-emesis = vomiting
gravidarum = pregnancy
Other Maternal Disorders
Predominately Related to
Pregnancy (O20-)29)
 Gestational phlebitis
 Hyperemesis gravidarum
 PUPP

Pruritic urticarial papules and plaques
prurit/o = itching
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Review Question
 Which of the following terms describes a pregnancy
that is “out of its (normal) place”?
A.
B.
C.
D.
HELLP
PUPP
eclampsia
ectopic pregnancy
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Word Parts
cephal/o = head
pelv/i = pelvis
-ic = pertaining to
cervic/o = cervix
The Fetus and Amniotic Cavity
and Possible Delivery
Problems (O30-O48)
 Cephalopelvic disproportion
 Cervical incompetence
 Malpresentation of fetus
-al = pertaining to
mal- = bad, abnormal
Malpresentation of fetus
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The Fetus and Amniotic Cavity and Possible
Delivery Problems (O30-O48)
 Abruptio placentae
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Word parts
erythr/o = red (blood
cell)
blast/o = immature
-osis = abnormal
condition
The Fetus and Amniotic Cavity
and Possible Delivery
Problems (O30-O48)
 Twin-to-twin transfusion
syndrome (TTTS)
 Erythroblastosis fetalis
Erythroblastosis fetalis
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Word Parts
olig/o = scanty
hydr/o = water, fluid
-amnios = amnion
poly- = excessive
The Fetus and Amniotic Cavity
and Possible Delivery
Problems (O30-O48)
 Oligohydramnios
 Polyhydramnios
 Chorioamnionitis
chori/o = chorion
amnion/o = amnion
-itis = inflammation
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Word Parts
placent/o = placenta
-it is = inflammation
previa = in front of
ac- = toward
cret/o = to grow
-a = noun ending
per- = through
The Fetus and Amniotic Cavity
and Possible Delivery
Problems (O30-O48)
 Placentitis
 Placenta previa
 Placenta accreta
 Placenta increta
 Placenta percreta
in- = in
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Word Parts
nuch/o = neck
-al = pertaining to
dys- = abnormal,
difficult
Complications of Labor and
Delivery (O60—O77)
 Nuchal cord
 Dystocia

Meconium staining
-tocia = labor, childbirth
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Word Parts
a- = without
galact/o = milk
-ia = condition
-rrhea = flow, discharge
hypo- = deficient, below
puerper/o = puerperium
Complications Predominantly
Related to the Puerperium
(O85-O92)
 Agalactia
 Galactorrhea
 Hypogalactia
 Puerperal sepsis
-al = pertaining to
sepsis = infection
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CM Guideline Alert
 15.k. Puerperal Sepsis
 Code O85, Puerperal sepsis, should be assigned with a
secondary code to identify the causal organism (e.g. for a
bacterial infection, assign a code from category B95-B97,
Bacterial infections in conditions classified elsewhere). A code
from category A40, Streptococcal sepsis, or A41, Other sepsis,
should not be used for puerperal sepsis. If applicable , use
additional codes to identify severe sepsis (R65.2-) and any
associated acute organ dysfunction. Needs additional code for
causal organism.
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Word Parts
Malignant Neoplasms (C58)
 Choriocarcinoma
chori/o = chorion
-carcinoma = cancer of
epithelial
origin
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Review Question
 Which term describes a condition of deficient
amniotic fluid?
A.
B.
C.
D.
chorioamnionitis
oligohydramnios
polyhydramnios
erythroblastosis fetalis
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Prenatal Diagnosis
 Alpha fetoprotein (AFP) test
 Contraction stress test (CST)
 Nonstress test (NST)
 Pregnancy test
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Word Parts
amni/o = amnion
-centesis = surgical
puncture
Prenatal Diagnosis
 Amniocentesis
 Chorionic villus sampling (CVS)
 Pelvimetry
chorion/o = chorion
pelv/i = pelvis
-metry = measuring
Amniocentesis
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Pregnancy and Delivery
 Cerclage
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Pregnancy and Delivery
 Cesarean section (C-section, CS)
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Word Parts
cephal/o = head
-ic = pertaining to
version = turning
episi/o = vulva
-tomy = cutting
vagin/o = vagina
-al = pertaining to
Pregnancy and Delivery
Procedures
 Cephalic version
 Episiotomy
 VBAC (vaginal birth after Csection)
 Vaginal delivery



Presentation
Assistance
PCS:
delivery = extraction
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Episiotomy
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PCS Guideline Alert
 C1
 Procedures performed on products of conception are coded to
the Obstetrics section. Procedures performed on the pregnant
female other than the products of conception are coded to the
appropriate root operation in the Medical and Surgical section.
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PCS Guideline Alert
 C2
 Procedures performed following a delivery or abortion for
curettage of the endometrium or evacuation of retained
products of conception are all coded in the Obstetrics section,
to the root operation Extraction and the body part Products of
Conception, Retained. Diagnostic or therapeutic dilation and
curettage performed during times other than the postpartum
or post-abortion period are all coded in the Medical and
Surgical section, to the root operation Extraction and the body
part Endometrium.
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Suffixes and Root Operations for Pregnancy, Childbirth,
and the Puerperium
 -centesis
 -metry
 -tomy
drainage (products of conception)
measurement
release, division, drainage
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Review Question
 Which term describes a procedure to turn the head
of the fetus towards the cervical outlet for a vaginal
delivery?
A.
B.
C.
D.
CS
cerclage
cephalic version
CVS
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Sort these terms into their correct categories
Terms
1. chorioamnionitis
2. agalactia
3. cerclage
4. amniocentesis
5. parturition
Categories
__ A + P
__ Pathology
__ Procedures
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