Unit 14 – Obstetrics Part 2

14.6 – Complications of Puerperium

HIMP 2210 – Health Data Classification II

Complications of Puerperium Following Delivery

• Postpartum Hemorrhage
 Increased bleeding following delivery
 Classification is based on cause:
 Uterine atony
 Retained placental tissue
 Coagulation defects in the mother

 Classified to O72.- Postpartum hemorrhage

Complications of Puerperium

• Postpartum Hemorrhage (PPH)

 Criteria for PPH code assignment:
 “PPH” is documented regardless the amount of blood loss

 Or “Uterine atony” in the postpartum period is

documented regardless of amount of blood loss

 Or based on postpartum blood loss volume is recorded as:

 Cesarean section > 1000 cc/ml
 Vaginal delivery > 500 cc/ml during 3rd stage of labour
 Immediate postpartum period or after first 24 hours following
delivery
Complications of Puerperium

• Postpartum Hemorrhage (PPH)

 Lead term: hemorrhage
 Secondary term: complicating delivery, due to
 Select code for the condition causing the blood loss

 Example: Delivery with blood loss due to an obstetrical

laceration is classified to O67.801

Hemorrhage
-complicating
--delivery
---due to
---trauma O67.8
Complications of Puerperium

• PPH due to coagulation defects

 Postpartum disseminated intravascular coagulation
 Thrombocytopenia
 Fibrinolysis
 abfibrinogenemia

 Lead term: Defect

 Secondary term: coagulation
 Subterm: postpartum O72.3
Complications of Puerperium

• PPH due to retained placental tissue

 Retention of part or all of placental tissue prevents the
uterus from contracting effectively and leads to PPH

Retention
-placenta (total) (with hemorrhage) O72.0
--portions or fragments (with hemorrhage) O72.2

Selection of the specific code depends on the etiology

and the time frame, use the following table:
Complications of Puerperium

• Classification of hemorrhage due to retained placental

tissue
Cause Time Frame Code

Retained, trapped or During the 3rd stage of labour O72.0 – Third stage hemorrhage
adherent placenta
with excessive O72.2 – Delayed and secondary
Any time other than during 3rd postpartum hemorrhage
bleeding stage of labour
Uterine atony or During the first 24 hours O72.1 – Other immediate
unknown/not following delivery postpartum hemorrhage
documented (i.e. PPH
NOS), regardless Between 24 hours and 6 weeks O72.2 – Delayed and secondary
amount of blood loss following delivery postpartum hemorrhage
recorded
Complications of Puerperium

• Diagnosis typing of PPH

• Always significant condition, and assigned a significant
diagnosis type

Diagnosis
PPH Codes
Type
• Applies to PPH if it is the only obstetrical condition
M recorded
• Not necessary to repeat as type 2 if MRDx

2 • PPH occurs after delivery of the infant, O72 is

assigned as type 2

• Note: O-codes that are significant prior to or during the delivery of the
infant is a type 1 diagnosis.
Complications of Puerperium
• Management of PPH
• Classified to 5.PC.91. ^^ Interventions to uterus (following
delivery or abortion)
• Code all the interventions at this rubric that apply
5.PC.91.^^ Description of intervention
GA • Dilation & curettage (D&C)

GC • Aspiration and curettage (suction)

GD • Dilation and evacuation (use of forceps)

HN • Manual removal of placenta from uterus

• Do not use this code when gentle traction on placenta from vagina
is used (this is normal)
• Do not use this for manual removal of placenta during C-section
HP • Manual correction of inverted uterus

HQ • Surgical correction of inverted uterus

HR • Manual exploration of uterine cavity

Complications of Puerperium
• Management of PPH continued
• Classified to 5.PC.91. ^^ Interventions to uterus (following
delivery or abortion)
5.PC.91.^^ Description of intervention
HT • Uterine (and vaginal) packing

HU • Bimanual compression and massage

HV • Compression using intrauterine balloon

LA • Suturing of uterus
• Includes: B-Lynch suture (for postpartum hemorrhage)

• PPH can also be managed by embolization of pelvic vessels

• Refer to pg. 119 to 121 – Guide to Obstetrical Coding
Other Complications of Puerperium

O85 – O92 Complications predominantly related to the

puerperium

 Used for those conditions developing within 6 weeks

or 42 days following delivery

 For conditions occurring after the 42-day time period,

but documented by the physician as postpartum –
code as a postpartum condition
Other Complications of Puerperium

• Postpartum infection:
 Most common puerperal complications
 Postpartum endometritis
O85.- Puerperal sepsis

• Venous complications:
 Deep vein thrombophlebitis and hemorrhoids
• O87.- Venous complications in the puerperium
Other Complications of Puerperium
Wound complications:
 Wound infections – includes perineal and cesarean section
wound infections
O86.0- Other puerperal infections, infection of obstetric
surgical wound

 Wound dehiscence
O90.0- Complications of the puerperium, not elsewhere
classified, disruption of caesarean section wound
O90.1- Complications of the puerperium, not elsewhere
classified, disruption of perineal obstetric wound
Other Complications of Puerperium

Admission to hospital following delivery:

 When delivery occurs outside hospital and patient
admitted immediately post delivery with no
complications, assign
Z39.0 Care and examination immediately after
delivery

 When there is a complication, code appropriate code

from Chapter XV with 6th digit of ‘4’ to indicate
postpartum
 Do not assign Z39.0 Care and examination immediately after
delivery