BOOK
Procedures in the Office Setting, An Issue of Obstetric and Gynecology Clinics, E-Book
(2013)
Additional Information
Book Details
Abstract
Gynecology is a procedure-related field that, like other specialties, has moved toward minimally invasive procedures that can be performed in the office setting. This issue of the Obstetrics and Gynecology Clinics covers the most commonly performed gynecologic procedures performed in the office setting. Colposcopy, Cryosurgery, LEEP, sterilization, D and C, and Urogynecologic procedures are all covered, along with articles on surgically implanted contraceptives and surgical abortion.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Procedures in the OfficeSetting\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Obstetrics And Gynecology Clinics\r | viii | ||
| Foreword\r | ix | ||
| Preface\r | xi | ||
| Patient Safety in the Obstetric and Gynecologic Office Setting | 611 | ||
| Key points | 611 | ||
| Introduction | 611 | ||
| Risks to patient safety in the office | 611 | ||
| Applicability to office practice in obstetrics and gynecology | 612 | ||
| Components of office safety | 615 | ||
| Leadership | 615 | ||
| Policy and Procedure Manual | 616 | ||
| Credentialing and Privileging | 616 | ||
| Safety Culture | 618 | ||
| Documentation | 619 | ||
| Medication Safety | 619 | ||
| Surgical Procedures | 620 | ||
| Equipment Safety | 621 | ||
| Other Considerations | 622 | ||
| Summary | 622 | ||
| References | 622 | ||
| Pain Relief for Obstetric and Gynecologic Ambulatory Procedures | 625 | ||
| Key points | 625 | ||
| Introduction | 625 | ||
| Anatomy of pain | 625 | ||
| Characteristics associated with pain | 626 | ||
| Safe use of analgesia and anesthesia | 626 | ||
| Analgesia | 627 | ||
| Anxiolysis | 628 | ||
| Combination Regimens | 629 | ||
| Local Anesthesia | 629 | ||
| Nonpharmacologic Techniques | 629 | ||
| Pain relief for ambulatory procedures | 630 | ||
| Tenaculum Placement | 630 | ||
| Colposcopy and Cervical Biopsies | 631 | ||
| Cervical Dilation and Uterine Aspiration | 632 | ||
| Paracervical block | 632 | ||
| Oral medications | 633 | ||
| NSAIDs | 633 | ||
| Opioid analgesics | 634 | ||
| Benzodiazepines | 634 | ||
| IV sedation | 635 | ||
| IUD Insertion | 635 | ||
| Office Endometrial Biopsy | 637 | ||
| Diagnostic Hysteroscopy | 638 | ||
| Hysteroscopic Sterilization | 639 | ||
| Summary | 640 | ||
| References | 640 | ||
| First-Trimester Surgical Abortion Technique | 647 | ||
| Key points | 647 | ||
| Introduction | 647 | ||
| Indications/contraindications | 648 | ||
| Technique/procedure | 648 | ||
| Preparation | 648 | ||
| Options counseling and consent | 648 | ||
| Medical history | 649 | ||
| Preprocedure tests | 649 | ||
| Clinical examination, dating, and ultrasound | 649 | ||
| Technique/procedure | 650 | ||
| Antibiotic prophylaxis to prevent postprocedural infections | 654 | ||
| Cervical preparation | 655 | ||
| Pain control | 658 | ||
| PCB | 658 | ||
| Oral Medications With PCB | 658 | ||
| IV Sedation | 658 | ||
| General Anesthesia | 658 | ||
| Music | 659 | ||
| MVA, EVA, mechanical dilation, and cannula | 659 | ||
| MVA | 659 | ||
| EVA | 659 | ||
| Cannula | 660 | ||
| Mechanical Dilators | 660 | ||
| Abortion before 7 weeks’ gestation | 660 | ||
| The difficult abortion | 660 | ||
| Complications and management | 662 | ||
| Hemorrhage | 662 | ||
| Cervical Lacerations | 662 | ||
| Uterine Perforation | 663 | ||
| Incomplete Abortion | 664 | ||
| Hematometra | 664 | ||
| Postabortal UGT Infections | 664 | ||
| Failed Attempted Abortion | 664 | ||
| Vasovagal Episode | 664 | ||
| Postoperative care | 665 | ||
| Contraception | 665 | ||
| Outcomes | 665 | ||
| Summary | 665 | ||
| References | 666 | ||
| Hysteroscopic Sterilization in the Office Setting | 671 | ||
| Key points | 671 | ||
| Introduction | 671 | ||
| Microinsert mechanism of action | 672 | ||
| Preoperative evaluation and preparation | 672 | ||
| Patient Selection | 672 | ||
| Counseling and Written Informed Consent | 672 | ||
| Preoperative Examination | 672 | ||
| Preoperative Laboratory Tests | 673 | ||
| Timing of Procedure | 673 | ||
| Premedication | 673 | ||
| Prophylactic Antibiotics | 674 | ||
| Considerations for the office procedure | 674 | ||
| Scheduling | 674 | ||
| Equipment | 674 | ||
| Office preparation | 674 | ||
| Practice Workflow | 674 | ||
| Equipment Checklist | 675 | ||
| Office Staff | 675 | ||
| State Regulations | 675 | ||
| Distention Medium | 675 | ||
| Patient Preparation | 677 | ||
| Patient Positioning | 677 | ||
| Anesthesia | 677 | ||
| Procedure | 678 | ||
| Complications and management | 679 | ||
| Adverse Events | 679 | ||
| Nickel Hypersensitivity | 679 | ||
| Trouble-Shooting Coil Placement | 679 | ||
| Management of Unsuccessful Microinsert Placement | 680 | ||
| Failed placement | 680 | ||
| Perforation or migration | 680 | ||
| Fluid Management | 681 | ||
| Patient Discomfort | 681 | ||
| Vasovagal Syncope | 681 | ||
| Postoperative care | 682 | ||
| Postprocedure Confirmation | 682 | ||
| Outcomes | 682 | ||
| Efficacy | 683 | ||
| Cost | 683 | ||
| References | 683 | ||
| Global Ablation Techniques | 687 | ||
| Key points | 687 | ||
| Introduction: nature of the problem | 687 | ||
| Indications/Contraindications | 687 | ||
| Performing the procedure | 690 | ||
| Complications and management | 690 | ||
| Late Complications | 691 | ||
| Outcomes | 692 | ||
| Current controversies/future considerations | 693 | ||
| Summary | 693 | ||
| References | 693 | ||
| Contraceptive Procedures | 697 | ||
| Key points | 697 | ||
| Intrauterine devices | 697 | ||
| Copper T 380A (TCu-380A) IUD | 698 | ||
| LNG intrauterine systems | 698 | ||
| Indications/Contraindications | 698 | ||
| Insertion and removal | 699 | ||
| ParaGard | 700 | ||
| Skyla | 702 | ||
| Mirena | 706 | ||
| Complications and management | 708 | ||
| Cramping and Pain | 708 | ||
| Perforation | 710 | ||
| Follow-up | 711 | ||
| Irregular Bleeding | 711 | ||
| Expulsion | 712 | ||
| String Problems | 712 | ||
| Pregnancy | 713 | ||
| Infection | 714 | ||
| Actinomyces-like Organisms on Papanicolaou Smear | 714 | ||
| Outcomes | 715 | ||
| Contraceptive implants | 715 | ||
| Indications/Contraindications | 716 | ||
| Technique/Procedure | 718 | ||
| Insertion | 718 | ||
| Removal | 720 | ||
| Complications and management | 722 | ||
| Insertion | 722 | ||
| Nonpalpable implant | 722 | ||
| Pain/paresthesia | 723 | ||
| Implant site reactions (pain, swelling, redness, hematoma) | 723 | ||
| Infection | 723 | ||
| Removal | 724 | ||
| Outcomes | 726 | ||
| Summary | 726 | ||
| References | 727 | ||
| Performance of a Colposcopic Examination, a Loop Electrosurgical Procedure, and Cryotherapy of the Cervix | 731 | ||
| Key points | 731 | ||
| Preparation | 731 | ||
| Colposcopic technique | 735 | ||
| Visualization of the cervix | 736 | ||
| Assessment of the cervix and abnormalities | 738 | ||
| Cervical biopsy | 740 | ||
| ECS | 741 | ||
| Documentation for colposcopy | 743 | ||
| Postcolposcopic instructions | 743 | ||
| Summary for colposcopy | 743 | ||
| Loop electrosurgical excision procedure | 743 | ||
| Indications | 744 | ||
| Patient Counseling and Preparation | 745 | ||
| Procedure | 748 | ||
| Postprocedure Care After LEEP | 750 | ||
| Performing cryotherapy | 750 | ||
| Indications | 750 | ||
| Patient Counseling and Preparation | 751 | ||
| Procedure | 753 | ||
| Postprocedure Care | 754 | ||
| References | 754 | ||
| Appendix A Colposcopy/LEEP assessment | 757 | ||
| Vulvar Procedures | 759 | ||
| Key points | 759 | ||
| Introduction | 759 | ||
| Anatomy | 759 | ||
| Vulvar biopsy | 760 | ||
| Bartholin cyst/abscess | 763 | ||
| Treatment of vulvar condyloma | 766 | ||
| References | 770 | ||
| Cystoscopy and Other Urogynecologic Procedures | 773 | ||
| Key points | 773 | ||
| Cystourethroscopy | 773 | ||
| Indications/Contraindications | 773 | ||
| Technique/Procedure | 773 | ||
| Rigid cystoscope | 773 | ||
| Flexible cystoscope | 773 | ||
| Distending media | 774 | ||
| Technique | 774 | ||
| Diagnostic | 774 | ||
| Operative | 775 | ||
| Complications and Management | 775 | ||
| Postoperative Care | 776 | ||
| Reporting, Follow-Up, and Clinical Implications | 776 | ||
| Outcomes | 776 | ||
| Current Controversies | 776 | ||
| Summary | 776 | ||
| Procedures for stress urinary incontinence | 776 | ||
| Single-Incision Slings | 776 | ||
| Periurethral Bulking Agents | 777 | ||
| Technique/procedure | 777 | ||
| Complications and management | 778 | ||
| Postoperative care | 778 | ||
| Reporting, follow-up, and clinical implications | 778 | ||
| Outcomes | 778 | ||
| Controversies | 778 | ||
| Procedures for urge urinary incontinence and overactive bladder | 779 | ||
| Percutaneous Nerve Evaluation | 779 | ||
| Technique/procedure | 779 | ||
| Complications and management | 779 | ||
| Postoperative care | 779 | ||
| Reporting, follow-up, and clinical implications | 780 | ||
| Outcomes | 780 | ||
| Controversies | 780 | ||
| Intravesical Injection of OnabotulinumtoxinA | 780 | ||
| Technique/procedure | 780 | ||
| Complications and management | 780 | ||
| Postoperative care | 780 | ||
| Reimbursement for Office-Based Gynecologic Procedures | 787 | ||
| Key points | 787 | ||
| Global surgical package | 788 | ||
| E&M services | 789 | ||
| Surgical modifiers | 790 | ||
| Facility fees for office-based surgery | 790 | ||
| Reimbursement for Pain Relief of Office-Based Gynecologic Procedures | 790 | ||
| Reimbursement for Surgical Abortion in the Office Setting | 791 | ||
| Reimbursement for Hysteroscopy and Hysteroscopic Sterilization in the Office Setting | 791 | ||
| Reimbursement for Global Ablation Techniques | 792 | ||
| Reimbursement for Intrauterine Device Placement/Removal, Etonogestrel/Nexplanon | 792 | ||
| Reimbursement for Colposcopy/LEEP/Cryotherapy | 793 | ||
| Reimbursement for Vulvar Procedures: Biopsy, Treatment of Bartholin Abscess, Treatment of Condyloma | 794 | ||
| Reimbursement for Cystoscopy and Other Urogynecologic Procedures | 794 | ||
| References | 795 | ||
| Index | 797 |