The patient is a 23-year-old female, gravida 2, para ). AB O. who was admitted to the hospital in the early morning hours reporting she had sporadic commacums for the past 24 hours.

ICD LO-PCS Coding Exercises 13 The patient is a 23-year-old female, gravida 2, para ). AB O. who was admitted to the hospital in the early morning hours reporting she had sporadic commacums for the past 24 hours. She is 38- and 1/i weeks’ gestation. A1 2:45 a.m. she had an artificial rupture of membrane, her cervix was + to 5 cm dilated and 90 percent effaced. She had variable fetal heart rate decelerations on the external fetal monitoring the fetal heart rate. She was pushing with some of her contractions, and the fetal distress appeared to whisen. Presentation was veriex, and station was minus I for most of the morning. The fetal head came down to about zero station. However, since the fetal distress did not abate, a long discussion was held with the patient and her mother shout a change in the management of her anticipated delivery. The physician recommended a cesarean delivery for the intrauterine pregnancy be performed because of the fetal distress caused by fetal heart rate decelerations, and the patient consented to it. A low cesarcan section was performed at 10 a.in. under spinal anesthesia, A viable male infant with spontaneous respiration and cry was delivered. ‘The cord was doubly clamped and cut, and the infant was placed in the warner and examined by the pediatrician. The mother’s placenta was removed. uterine cavity cleaned, and the uterine incision closed in two layers. Careful inspection of the uterus, fallopian tubes, and ovaries did not reveal any unusual findings or bleeding. The peritoneum was closed vertically, and the fascia was closed. Subcutaneous tissue was closed with plain silk, and the skin was closed with subcuticular sutures followed by staples. The patient received Pitocin and a gram of Ancef, per protocol. The patient’s estimated blood loss was about 500 oc with no surgical complications. Postoperatively the patient complained of the typical abdominal discomfort from the incision. The patient was known to have microcynic anemia during her pregnancy, and the anemia was present at the time of delivery and at discharge as well. The anemia continued to he treated. The patient was discharged with her newborn son on day 3 with a follow-up appointment in the obstetrician’s office in 10 days. Principal Diagnosis: Secondary Diagnoses: Principal Procedure: Secondary Procedure(s):