Chapter XV - Pregnancy, childbirth and the puerperium

Question 1

When should a code from category Z37.- Outcome of delivery be assigned and in what position?

Answer 1

Must be assigned on the mother’s delivery episode only, to identfy whether the delivery resulted in a liveborn or stillborn infant(s).

Can be sequenced in any secondary position, NEVER in primary.

Question 2

What types of episode should codes in category Z37.- Outcome of delivery not be used for?

Answer 2

Must not be used on patients who have undergone termination of pregnancy or suffered a miscarriage that has resulted in the delivery of a dead fetus whilst in hospital.

Question 3

What does the term ‘abortion’ describe within the ICD-10 classification?

Answer 3

Both ‘miscarriage’ and ‘termination of pregnancy’

Question 4

What is meant by the term ‘live birth’?

Answer 4

Complete expulsion or extraction of a fetus from its mother, which, after seperation, breathes or shows any other evidence of life (irrespective of the duration of pregnancy)

Question 5

What is gestational age?

Answer 5

The estimated age of a fetus, usually calculated by ultrasound scan.
GA is expressed in completed weeks.

Question 6

What are RPOC?

Answer 6

Retained products of conception - the retention of any part of the placental tissue, membranes, gestation sac or fetal pole following miscarriage, TOP or delivery of pregnancy.

Question 7

What is the puerperium?

Answer 7

the 42 days following the end of the second stage of labour

Question 8

When should the code O02.1 Missed abortion (missed miscarriage) be assigned?

Answer 8

Only when there has been no bleeding and no POC have been passed.

Question 9

When assigning a code for O03.- Spontaneous miscarriage, what does the 4th character code assignment show?

Answer 9

Whether the miscarriage was incomplete or complete and if there were any maternal complications.

Question 10

What is an incomplete miscarriage?

Answer 10

The miscarriage has started, bleeding is present but not all of the fetal tissue has been passed. RPOC are present.

Question 11

What is a complete miscarriage?

Answer 11

The pregnancy has been lost, the uterus is empty and there are no RPOC.

Question 12

What are other terms that may be used to described a missed abortion/missed miscarriage?

Answer 12

• Early fetal demise
• Early uterine death
• Silent miscarriage
• Delayed miscarriage

Question 13

What is a missed miscarriage?

Answer 13

The retention of a dead fetus before 24 completed weeks of gestation.
Diagnosed before any bleeding has taken place, e.g. at a routine antenatal scan

Question 14

What is a spontaneous miscarriage?

Answer 14

The expulsion of the baby or fetus before the 24th completed week without deliberate interference, and is a natural end to the pregnancy.

Question 15

How may Hydatidiform mole (O01) also be referred to?

Answer 15

Gestational trophoblastic disease

Question 16

How should an MTOP resulting in a live birth be coded?

Answer 16

• A code for the abortion O04-O06 +
• Z37.- Outcome of delivery (to show that it resulted in a live birth)

Question 17

When is the only time a code from O06.- Unspecified abortion can be assigned?

Answer 17

Inadvertent loss of pregnancy due to direct cause.
When a patient undergoes uterine surgery (eg hysterectomy) and the pregnancy is unavoidably terminated due to the nature of the procedure.

Question 18

When should codes in category O20.- Haemorrhage in early pregnancy be assigned?

Answer 18

Must be used for any vaginal bleeding before 24 completed weeks of gestation.
Exception - when the pregnancy proceeds to abortive outcome (use O00-O08 instead).

Question 19

When can codes from category O21.- Excessive vomiting in pregnancy be assigned?

Answer 19

Only when the patient has been admitted because of, or is being treated for, the vomiting.

Question 20

How should Diabetes mellitus in pregnancy, childbirth and the puerperium always be coded?

Answer 20

Using a code from category O24.- Diabetes mellitus in pregnancy
If there are manifestations of the diabetes, these must be coded in addition (with D&A codes where appropriate).

Question 21

How is ‘stillbirth’ defined?

Answer 21

A baby delivered with no signs of life, known to have died after 24 completed weeks of pregnancy.

Question 22

When must the code O48.X Prolonged pregnancy be assigned?

Answer 22

If the pregnancy exceeds 42 weeks or if the responsible consultant documents that the patient is ‘post-term’ or ‘post-dates’.

Question 23

When can codes in categories O80-O84 Delivery be assigned?

Answer 23

Only when the only information recorded is a statement of ‘delivery’ or when the method of delivery has been recorded and the patient has no other conditions classifiable to Chapter XV.

Question 24

What is meant by the term ‘Grand multiparity’?

Answer 24

A woman who has given birth to five or more infants, alive or dead.

Question 25

What is meant by the term ‘Elderly primagravida’?

Answer 25

A woman pregnant for the first time who is 35 years of age or older.