4. PROCEDURE: Hysterectomy, abdominal (68.4) or vaginal (68.5)
A. Indication: Abnormal uterine bleeding in women of reproductive age (626 all, except 626.0, 626.1, 626.3, 626.7). Note: Other diagnoses that should also be evaluated according to these criteria include menorrhagia (626.2, 627.0), hypermenorrhea (626.2).
Confirmation of indications, all of which must exist:
(1) History of all of the following:
(a) Either or both excessive uterine bleeding and irregular uterine bleeding defined as bleeding for more than 8 days during more than a single cycle and profuse bleeding requiring additional protection; (e.g., large clots, gushes, limitations on activity).
(b) No history of a bleeding diathesis or use of medication that may cause bleeding;
(c) Negative effect on patient's quality of life.
(2) Failure to find, on physical examination, uterine or cervical pathology that would cause abnormal bleeding.
(3) Laboratory data
(a) No finding of endometrial neoplasia;
(b) No malignancy found in cytological studies of cervix;
(4) No finding of endometrial polyps by D&C, hysterscopy, or hysterogram.
B. Actions Prior to Procedure:
(1) Determine that attempted hormone treatment (estrogen-progestogen) was not successful or contraindicated or refused;
(2) Hemoglobin or hematocrit documented;
(3) Document and attempt to correct anemia if present;
(4) Offer autologous blood donation if appropriate; and
(5) Document patient education and informed consent.
C. Contraindication:
(1) Desire to maintain fertility.
(Reference: Quality Assurance in Obstetrics & Gynecology 1989 ed.)
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