UM Guidelines

	Added:

Care Planning - Inpatient Admission and Alternatives

Clinical Indications for Procedure

• Vaginal prolapse is indicated with ALL of the following:
  • Absence of ALL of the following (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
  • 1 or more of the following:
  • Following prior hysterectomy with 1 or more 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
      
  • With intact uterus including 1 or more 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

Alternatives to Procedure

• Pessary
• Vaginal suspension via a vaginal approach

Hospitalization

Goal Length Of Stay: Observation

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. BlueCross BlueShield of Tennessee network physicians. September - December 2012.
2. Mahaer, C., Baessler, K., Glazener, CMA, Adams, E. J., Hagen, S. Surgical management of pelvic prolapse in women. The Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD00401.
3. National Guideline Clearinghouse. Urinary incontinence in women. (2005, June - reaffirmed 2009). Retrieved August 11, 2009 from http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10931&nbr=5711.
4. Stenchever, M, Comprehensive Gynecology, 4th ed., Copyright © 2001 Mosby, Inc.