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T11-4 OPERATIVE REPORT, AMNIOCENTESIS LOCATION: Inpatient, Hospital PATIENT: Patricia Garrison ATTENDING PHYSICIAN: Andy Martinez, MD SURGEON: Andy Martinez, MD PREOPERATIVE DIAGNOSES: Intrauterine pregnancy at 32 plus weeks. Insulin-dependent diabetes. Diabetic nephropathy. POSTOPERATIVE DIAGNOSES: Intrauterine pregnancy at 32 plus weeks. Insulin-dependent diabetes. Diabetic nephropathy. PROCEDURE PERFORMED: Amniocentesis ANESTHESIA: NONE INDICATIONS: The patient is a 26-year-old woman with a complicated pregnancy, who has been on bedrest because of diabetic nephropathy. Due to the fact that the fetus might be in a hostile environment, we felt that accelerated pulmonary maturity might be a possibility; therefore, at this time, we elected to go with amniocentesis to help us manage her pregnancy. She had been fully informed of the risks and benefits of the procedure prior to proceeding. DESCRIPTION OF PROCEDURE: Ultrasound scanning was done by the technologist, and placenta was posterior. We prepped the abdomen and draped it. We used a sterile covered ultrasound transducer with guide and located a pocket of fluid (do not report the ultrasound guidance). The 20-gauge needle was inserted. As we got into the uterus, the baby moved into the area; therefore, the needle was immediately withdrawn. The fetus was palpated a little bit, and we stimulated the baby and it moved out of the area. We then repositioned the transducer, and we were able to drop into the pocket of amniotic fluid and withdraw 20 cc of clear yellow amniotic fluid. The fluid was sent for maturity studies. The patient tolerated the procedure without difficulty. T11-4: CPT CODE: 1 (Code amniocentesis, diagnostic) ICD-10-CM CODES: 3 (Code pregnancy complicated by, diabetes, pre-existing, type 2) (Code diabetes, type 2, with, nephropathy) (Code long term drug use, insulin)

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