3. PROCEDURE: Hysterectomy, abdominal (68.4) or vaginal (68.5)
A. Indication: Leiomyomata (218.0-218.9). Note: Other diagnoses should also be evaluated according to these criteria include menorrhagia (626.2, 627.0) hypermenorrhea 626.2.
Confirm the indication by the presence of one or more of the following:
(1) Asymptomatic myomata. associated with a uterine size equal to or larger than that after 12 weeks gestation, determined by physical examination or ultrasound examination.
Note: Transverse measurement of at least 8 cm or weight of 280 g or more (see Table 1) (included)
TABLE 1
UTERINE SIZE AND WEIGHT
Type of Uterus Size (cm) weight (g)
Normal Uterus
Nulliparous 5 70
Multiparous 6 75-125
Enlarged Uterus
(gestational age)
8 weeks 6 125-150
12 weeks 8 280-320
24 weeks 18 580-620
Term 1,000 1,100
(2) Excessive uterine bleeding evidenced by either a or b:
(a) Bleeding for more than 8 days during more than a single cycle and profuse bleeding (i.e., large clots, gushes, limitations on activity) requiring additional protection;
(b) Anemia due to acute or chronic blood loss.
(3) Chronic pelvic pain for 6 months or longer with a negative effect on patient's quality of life.
(4) Rapid growth in size of uterus/myomata, to a point equal to or larger than that after 12 weeks gestation.
B. Actions Prior to Procedure:
(1) Confirm by cytologic study the absence of cervical pathology. No malignancy found.
(2) Obtain endometrial sample or perform D&C (when abnormal bleeding is present).
(3) Document and attempt to correct anemia if present.
(4) Offer autologous blood donation if appropriate.
(5) Document patient education and informed consent.
C. Contraindication:
(1) Desire to maintain fertility.
(References: Quality Assurance in Obstetrics & Gynecology-1989
ed.)
