11/12/1990
Gender: F
Patient Type: Inpatient
Reason for Visit: Cervical Incompetence
Notes/Comments: Unit 3 Case Study 2
PREOPERATIVE
DIAGNOSIS: Cervical incompetence
POSTOPERATIVE
DIAGNOSIS: Cervical incompetence
OPERATION: Transabdominal cervical cerclage with broad Mersilene tape
INDICATIONS: This is a 28-year old female discovered to have cervical incompetence and wishes to have this
corrected. She presents today for a cervical cerclage.
PROCEDURE: The patient was taken to the OR prepped, draped and placed under general anesthesia.
Attention was turned to her abdomen where a transverse suprapubic incision was made. The vesical
peritoneum overlying the lower uterine segment was divided transversely. The bladder and paravesical tissues
were pushed caudally until the supravaginal cervix could be seen and palpated in the midline with good
exposure laterally. The uterine vessels were displaced laterally, opening the paracervical connective tissue
space. The needle was passed anteroposteriorly above the paracervical vessels immediately adjacent to the
cervix at the level of the cervicoisthmic junction superior to the medial insertions of the uterosacral ligaments,
care being taken to retract the uterine vessels laterally and to guide the needle tip with fingers behind the
broad ligament. Before being pulled through completely, the band width of the tape was verified as being
flush with the anterior cervicoisthmic tissues. The knot was then tied in the posterior. She was extubated and
taken to recovery room in stable condition, without any complications.
What's the Pcs code