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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Abortion, Surgical


Text Only Home | Graphic-Rich Site | Overview | Reason for Procedure | How Procedure is Performed | Prognosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Medical Codes | References

Medical Codes

ICD-9-CM:
69.01 - Dilation and Curettage for Termination of Pregnancy
69.51 - Aspiration Curettage of Uterus for Termination Pregnancy; Therapeutic Abortion NOS

Related Terms

  • Elective Abortion
  • Termination of Pregnancy, TOP
  • Therapeutic Abortion

Overview

Abortion is a surgical procedure used to terminate a pregnancy. Elective abortion refers to termination of a pregnancy for nonmedical reasons at the request of the individual. Therapeutic abortion is the termination of a pregnancy for medical reasons, such as life-threatening consequences for the mother (e.g., ectopic pregnancy), situations of rape or incest, fetal abnormalities, death of a fetus, or to selectively reduce a multifetal pregnancy. The majority of surgical abortions in the US are elective (James).

The particular surgical procedure varies, depending on the duration of pregnancy. If an abortion is performed up to 10 weeks after the woman's last menstrual period, the procedure used is manual vacuum aspiration (MVA). From 10 weeks until 14 weeks, the procedure used is dilation and suction curettage (D&C). After 14 weeks of pregnancy, a surgical abortion is performed by a dilation and evacuation (D&E) procedure. After 20 weeks, an abortion is performed by labor induction, intra-amniotic saline infusion, prostaglandin labor induction, removal of the fetus through an incision in the uterus (hysterotomy), or intact dilation and extraction. Late-term surgical abortion may be performed by vaginally delivering the fetus before termination, usually to preserve the life of the mother. Before 20 weeks, these procedures often are performed in a doctor's office with sedation and local anesthesia (outpatient). After 20 weeks, an abortion usually is performed in a hospital.

Source: Medical Disability Advisor



Reason for Procedure

Abortion is performed to terminate pregnancy in situations of unwanted pregnancy or when adverse medical conditions are present.

Source: Medical Disability Advisor



How Procedure is Performed

All abortion procedures are performed with the woman in the same position used for a pelvic examination, that is lying on an examination table with legs externally rotated and knees flexed and supported in stirrups. An MVA involves inserting a dilator that gradually stretches the cervix open (dilation). After local (cervical) anesthesia is administered, a manual syringe or a small-bore cannula attached to a suction machine is inserted. Suction then empties the uterus. This procedure takes about 10 minutes.

For dilation and suction curettage (D&C), a local anesthetic (paracervical block) is administered. The cervix is dilated until the opening is large enough to admit the tip of suction tubing into the uterus. Suction is activated as the surgeon gently rotates the suction tip to remove the contents of the uterus. Occasionally, a plastic scraping device (curette) or metal forceps may be used to ensure that the procedure is complete. Dilation and suction curettage takes about 10 to 15 minutes. In both MVA and D&C, most individuals can go home after a few hours of observation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control pain following these procedures.

A D&E procedure, which is infrequently performed, involves increased dilation of the cervix (which may take several hours) and removal of a mostly intact fetus, often with the use of ultrasound for guidance. Other second-trimester procedures, which also are rarely performed, include labor-induction methods with prostaglandin and, in very rare instances, a hysterotomy, in which the fetus and placenta are surgically removed through an incision in the uterus, or a procedure in which the membranes are ruptured and the fetus is delivered. This method is used only when all other methods of abortion have failed or are contraindicated.

Source: Medical Disability Advisor



Prognosis

The predicted outcome—termination of pregnancy without complications—is good. With a manual vacuum aspiration or a dilation and suction curettage abortion, most women experience no problems associated with the anesthesia or the procedure. Aftereffects are minimal, although a few individuals experience faintness, some bleeding, and mild menstrual-like cramping for a day or two following the procedure. Hospitalization usually is not required. Although the duration of bleeding varies widely, the volume of bleeding is similar to what occurs during a menstrual cycle and should not continue longer than 2 weeks. If bleeding soaks more than 1 pad per hour, the woman should consult her physician.

A woman should schedule a follow-up appointment with her physician 2 to 4 weeks after the abortion to make sure there are no problems or complications and that all pregnancy tissue was removed. The woman and her physician should discuss the possibility of psychological counseling, because the decision to have an abortion and the actual procedure are potentially psychologically traumatic, particularly if the pregnancy is advanced.

Source: Medical Disability Advisor



Specialists

  • Family Physician
  • Gynecologist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications are uncommon, and include perforation of the uterus, excessive bleeding (hemorrhage) due to incomplete removal of the products of conception, trauma to abdominal organs (e.g., rupture of bowel or bladder), pelvic inflammation and infection, and laceration or damage to the cervix. Laceration or damage to the cervix often results in the inability to retain the fetus within the uterus (cervical incompetence) in future pregnancies, resulting in miscarriage (spontaneous abortion) or premature birth. More dilation of the cervix is required for the dilation and suction curettage procedure, so more cramping occurs, and there is a slightly greater risk of complications than with the MVA procedure.

For surgical abortion during the first trimester, the risk of complications is low, including vaginal bleeding (0.007%), uterine perforation (0.009%), sepsis (0.021%), incomplete abortion (0.028%), and infection (0.46%) (Lyus).

With MVA, risk of complications includes uterine perforation (0.05%), retained pregnancy-related tissues (0.5%), and infection (0.7%) (Lyus).

Complications to abortions performed later in the pregnancy include cervical scarring and stenosis, uterine adhesions (Asherman syndrome), postinfection tubal damage, and mandatory Caesarean delivery for pregnancies following a hysterotomy.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability may be influenced by the stage of pregnancy, the method of an abortion, and the development of complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions or accommodations usually are not required; most individuals can return to regular activities and to work soon after the procedure. However, strenuous physical activity should also temporarily be modified. Returning to work on a part-time basis may be advised until the woman regains her normal strength and stamina. During this time, accommodations may include the option of adjusted work hours for a few days after returning to work, with time allotted for rest periods in a comfortable, quiet, on-site environment. If complications arise, extended sick leave may be required.

Source: Medical Disability Advisor



References

Cited

James, D., and N. E. Roche. "Therapeutic Abortion." eMedicine. Ed. Anthony Charles Sciscione. 2 Jun. 2006. Medscape. 16 Jul. 2009 <http://emedicine.medscape.com/article/266440-overview>.

Jazayeri, A., and H. S. Coussons. "Surgical Management of Ectopic Pregnancy." eMedicine. 7 Jan. 2008. Medscape. 16 Jul. 2009 <http://emedicine.medscape.com/article/267384-overview>.

Lyus, Richard John, Paul Gianutsos, and Marji Gold. "First Trimester Procedural Abortion in Family Medicine." Journal of the American Board of Family Medicine 22 2 (2009): 169-174.

General

"Abortion." Alan Guttmacher Institute. 2009. 16 Jul. 2009 <http://www.guttmacher.org/sections/abortion.html>.

"Elective Abortion." eMedicine. 22 Dec. 2008. Medscape. 16 Jul. 2009 <http://emedicine.medscape.com/article/252560-overview>.

Trupin, Suzanne R. "Elective Abortion." eMedicine. Ed. David Spandorfer. 22 Dec. 2008. Medscape. 16 Jul. 2009 <http://emedicine.medscape.com/article/252560-overview>.

Source: Medical Disability Advisor