UM Guidelines

	Added:

(Beginning of BCBST modification effective September 28, 2006*)

Care Planning - Inpatient Admission and Alternatives

Clinical Indications for Procedure

• Vaginal prolapse after prior hysterectomy, including ANY ONE of the following:
  • Complete protrusion or eversion of vaginal vault through introitus
  • Partial vaginal prolapse to introitus, symptomatic with vaginal cuff chronic irritation
  • Partial vaginal prolapse to introitus accompanied by occupational stress factors such as prolonged standing and extensive lifting (e.g. operating room technician)
  • Partial vaginal prolapse to introitus following a failed, previous reconstructive suspension
    
• Vaginal prolapse with intact uterus including ANY ONE of the following:
  • The cervix and vaginal fornices completely protrude through the introitus and there is a high risk of failure for vaginal suspension
  • Short vagina
  • Occupational stress factors
• Cases not appropriate for abdominal sacral colpopexy
  • Patients with active vaginal or perineal infections
  • Patients who are elderly and/or are in poor health with serious co-morbidities
  • Patients who have had treatment for cancers in the pelvic area, including gynecologic, bladder and sigmoid/anal cancers

Alternatives to Procedure

• Pessary
• Vaginal suspension via a vaginal approach

Hospitalization

Goal Length Of Stay: [2 days postoperative]* (BCBST modification effective September 28, 2006*)

Note: Goal length of stay assumes optimal recovery, decision-making, and care. Patients may be discharged to a lower level of care (either later than or sooner than the goal) when it is appropriate for their clinical status and care needs.

Extended Stay

• Persistent fever > 100.5 F
• Persistent, active and uncontrolled bleeding (May include signs of expanding retroperitoneal hematoma.)
• Signs of genuine ileus as exhibited by absent bowel sounds, no bowel movements or flatus AND distension

Discharge Destination

• Home

References

1. Nygaard, Ingrid E, et. al., Abdominal Sacrocolpopexy: A Comprehensive Review, Obstetrics and Gynecology, VOL. 104, NO. 4, OCTOBER 2004.
2. Stenchever, M, Comprehensive Gynecology, 4th ed., Copyright © 2001 Mosby, Inc.
3. Walsh, P: Campbell's Urology, 8th ed., Copyright © 2002 Elsevier

(End of BCBST modification effective September 28, 2006*)

* These guideline(s) have been revised from the Milliman USA Milliman Care Guidelines.  The portions of the guideline(s) which have been revised are identified through the use of [insert: italic, boldface, underlined, etc. as appropriate] text, and Milliman USA has neither reviewed nor approved the modified material.  Any statement to the contrary or association of the modified material with Milliman USA is strictly prohibited. This document has been classified as public information.

The above information only contains the modified portion of the Milliman Care Guideline. If you wish to view the complete Milliman Care Guideline, please contact Milliman USA.