PROPÓSITO DE LA INVESTIGACIÓN
6.3 Nuevas formas de relacionamiento
There are three types of complications associated with ectopic pregnancy, molar pregnancy, miscarriage and termination of pregnancy, these are explained in detail below and summarised diagrammatically following this section.
1.
Maternal complications of ectopic pregnancy, molar
pregnancy, miscarriage and termination of pregnancy
(abortion)
The first type of complication refers to maternal complications; conditions affecting the mother which cause, result from, or are otherwise associated with the ectopic pregnancy, molar pregnancy, miscarriage or termination of pregnancy.
A table of complications is shown in the Alphabetical Index under the term Abortion, complicated (by). This table identifies the fourth character subdivisions to be used for miscarriages and terminations of pregnancy as follows:
Miscarriage
• First column identifies the fourth character to be used with category O03, when complete or unspecified.
• Second column identifies the fourth character to be used with category O03, when incomplete.
Termination of pregnancy
• First column identifies the fourth character to be used with categories O04–O06, when complete or unspecified.
• Second column identifies the fourth character to be used with categories O04–O06, when incomplete.
The third column identifies the fourth character to be used with category O08.
Code assignment for maternal complications is dependent upon when the complication occurred. Maternal complications of miscarriage and
termination of pregnancy themselves can be classified in three different ways.
a. Firstly, maternal complications occurring during the same consultant episode as the ectopic pregnancy, molar pregnancy, miscarriage or termination of pregnancy itself are classified using codes in categories O00––O07. Categories O03–O06 all require the assignment of a fourth character to identify the type of complication, e.g. haemorrhage.
A code from category O08 Complications following abortion and ectopic and molar pregnancy must be used in addition to the codes from the range O00–O02 to identify any associated complications, and may be used with categories O03–O07 to give further information about the complication if it is not stated at four character level.
Example: Pelvic peritonitis following a tubal pregnancy. Same consultant
episode as tubal pregnancy.
Index trail for the tubal pregnancy: Pregnancy (single) (uterine)- tubal (with abortion) (with rupture) O00.1 Tabular List entry:
O00.1 Tubal pregnancy
Index trail for the peritonitis:Peritonitis (adhesive) (fibrinous) (with effusion) K65.9 - following
- - ectopic or molar pregnancy O08.0 Tabular List entry:
O08.0 Genital tract and pelvic infection following abortion and ectopic and molar pregnancy
Rationale: Code O08.0 must also be assigned to identify the associated complication of pelvic peritonitis.
Example: Incomplete spontaneous miscarriage with pelvic peritonitis during
same consultant episode
Index trail for abortion:Abortion (complete) (incomplete) O06.- - spontaneous O03.-
or
Miscarriage O03.- Tabular List entry:
O03 Spontaneous abortion
[See before O00 for subdivisions]
.0 Incomplete, complicated by genital tract and pelvic infection
Rationale: It is not necessary to assign code O08.0 Genital tract and pelvic infection following abortion and ectopic and molar pregnancy in addition as it adds no further information about the complication. The
complication of pelvic peritonitis is indicated at fourth character level within code O03.0 Spontaneous abortion incomplete, complicated by genital tract and pelvic infection.
Example: Complete spontaneous miscarriage with renal failure in the same consultant episode as the miscarriage
Index trail for abortion:Abortion (complete) (incomplete) O06.- - spontaneous O03.-
or
Miscarriage O03.-
Tabular List entry:
O03 Spontaneous abortion
[See before O00 for subdivisions]
.8 Complete or unspecified, with other and unspecified complications
Index trail for renal failure: Failure, failed- renal – see Failure, kidney - kidney N19
- - following
- - - abortion (subsequent episode) O08.4 - - - - current episode – see Abortion Tabular List entry:
O08.4 Renal failure following abortion and ectopic and molar pregnancy
Rationale: Code O08.4 is used in addition to code O03.8 as it adds further specificity about the complication.
Pregnancy-related complications occurring during the same consultant episode as the ectopic pregnancy, molar pregnancy, miscarriage or termination of pregnancy, but not associated with the ectopic pregnancy, molar pregnancy, miscarriage or termination of pregnancy process, are coded separately.
Example: Incomplete spontaneous miscarriage with excessive haemorrhage,
the patient is also treated for severe pre-eclampsia during the same consultant episode.
Index trail for the abortion:Abortion (complete) (incomplete) O06.- - spontaneous O03.-
or
Miscarriage O03.- Tabular List entry:
O03 Spontaneous abortion
[See before O00 for subdivisions]
.1 Incomplete, complicated by delayed or excessive haemorrhage
Index trail for severe pre-eclampsia: Pre-eclampsia O14.9- severe O14.1 Tabular List entry:
O14.1 Severe pre-eclampsia
The sequencing of codes may on occasion change to accurately reflect the main condition treated. This follows the primary diagnosis definition.
Example: Patient admitted with severe pre-eclampsia, and during this
consultant episode an incomplete miscarriage also occurred.
Index trail for severe pre-eclampsia: Pre-eclampsia O14.9- severe O14.1 Tabular List entry:
O14.1 Severe pre-eclampsia
Index trail for the abortion:Abortion (complete) (incomplete) O06.- - spontaneous O03.-
or
Example (cont):
Tabular List entry:
O03 Spontaneous abortion
[See before O00 for subdivisions] .4 Incomplete, without complication
b. The second type of maternal complication refers to maternal
complications occurring on a subsequent consultant episode where the patient has retained products of conception following a previous medical termination of pregnancy or spontaneous miscarriage. These are recorded as follows:
Retained products of conception after previous medical termination
of pregnancy
Medical termination of pregnancy episode
This must be coded as a complete medical termination of pregnancy on completion of the procedure. The code assigned would be from category O04 Medical abortion, with the relevant fourth character from .5 to .9 to indicate a complete termination of pregnancy.
Retained products of conception episode (following previous medical termination of pregnancy)
This must be coded as an incomplete medical termination of pregnancy by assigning a code from category O04, with the relevant fourth character from .0 to .4 to indicate an incomplete termination of pregnancy.
Retained products of conception after previous spontaneous miscarriage.
Spontaneous miscarriage episode
This must be coded as a spontaneous miscarriage using O03
Spontaneous abortion with the appropriate fourth character from .0 to .9, as a spontaneous miscarriage can be either complete or incomplete. Retained products of conception episode (following previous
spontaneous miscarriage)
This must be coded as an incomplete spontaneous miscarriage, assigning a code from category O03, with the relevant fourth character from .0 to .4 to indicate an incomplete miscarriage. Even if a procedure for the retained products of conception (e.g. ERPC) was carried out on the previous spontaneous miscarriage episode, the retained products episode would still be coded to an incomplete spontaneous miscarriage, as it is considered to be ongoing treatment of a spontaneous
c. The third type of maternal complications are those occurring in a subsequent consultant episode to that in which the ectopic pregnancy, molar pregnancy, miscarriage or termination of pregnancy occurred, and where there are no retained products of conception. These are classified using codes in category O08 Complications following abortion and ectopic and molar pregnancy.
A code from O08 must not be used as a primary diagnosis code except where the new consultant episode is solely for treatment of a
complication of a previous miscarriage or termination of pregnancy.
Example: Patient re-admitted with pelvic peritonitis following a medical
termination of pregnancy performed five days previously. No retained products of conception present.
Index trail for the peritonitis:Peritonitis (adhesive) (fibrinous) (with effusion) K65.9 - following
- - ectopic or molar pregnancy O08.0 Tabular List entry:
O08.0 Genital tract and pelvic infection following abortion and ectopic and molar pregnancy
Rationale: In this example a code from category O08 is the only code required as there is no current termination of pregnancy, only a previous termination of pregnancy. If retained products of conception were present, this would be coded to O04.0 Medical abortion, incomplete, complicated by genital tract and pelvic infection.