Sign-in
(your email):
(case sensitive):



 
 

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.

Dilation and Curettage


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
69.02 - Dilation and Curettage Following Delivery or Abortion
69.09 - Other Dilation and Curettage of Uterus; Diagnostic D and C

Related Terms

  • D&C
  • Suction Dilation and Curettage

Overview

Dilation and curettage (D&C) is a common minor surgical procedure in which the opening to a woman's uterus (cervix) is enlarged (dilated), and the lining of the uterus (endometrium) is scraped with a loop- or spoon-shaped instrument (curette). The scraping or removal of the endometrium causes no side effects, and the endometrium soon grows back to become a part of the normal menstrual cycle.

Individuals with a history of dysfunctional uterine bleeding such as heavy periods (menorrhagia), bleeding between periods (intermenstrual bleeding or spotting), bleeding during or after intercourse, or bleeding after menopause may require a D&C procedure to assess the cause of abnormal bleeding (ACOG). Individuals with cancer of the uterus or other growths in the uterus, a suspected tubal (ectopic) pregnancy, an incomplete miscarriage, or those with tissue remaining after a delivery also may need a D&C procedure to obtain a tissue sample (biopsy), remove abnormal tissue (e.g., small uterine fibroids), prevent fetal growth in a life-threatening location, or prevent infection (Moses). D&C also can be used to terminate a pregnancy (elective or therapeutic abortion) or to remove tissue remaining after an incomplete abortion.

Source: Medical Disability Advisor



Reason for Procedure

The D&C is used to treat or evaluate dysfunctional uterine bleeding (DUB), which includes heavy periods (menorrhagia), bleeding between periods, bleeding during or after intercourse, or bleeding after menopause. By removing excess uterine lining, D&C may prevent DUB, albeit sometimes only temporarily. D&C serves as a basis for testing and diagnosis of cancer of the uterus or other growths in the uterus, such as polyps and fibroid tumors. Testing procedures that may be employed with the D&C include ultrasonography, laparoscopy, and hysteroscopy.

D&C also is used to remove the remaining tissue following an incomplete miscarriage, an incomplete abortion, or to remove retained pregnancy tissue after a delivery. The procedure can be used to terminate early pregnancy (elective or therapeutic abortion).

Source: Medical Disability Advisor



How Procedure is Performed

A D&C is performed with the woman in the same position that is used for a pelvic examination, that is lying on an examination table with legs externally rotated and knees flexed and supported in stirrups (dorsal lithotomy position). With the individual anesthetized using conscious sedation and local or spinal anesthesia, or general anesthesia, the gynecologist begins the surgery by inserting a thin rod called a sound through the cervix and into the uterus to measure its depth. Next, a dilator is inserted, and as the cervix stretches open (dilates), the gynecologist inserts dilators of increasing thickness until an opening is large enough to begin the second phase of the surgery.

In the second phase of the surgery, a curette is inserted into the uterus to scrape away the endometrium. The endometrium also can be removed by inserting into the cervix a hollow tube (catheter) that is connected to a vacuum pump. Suction is then applied to remove the retained tissue. Antibiotics may be given to prevent infection. The entire D&C procedure takes about 15 minutes, and the individual usually is able to go home within 4 to 6 hours. However, if general anesthesia or conscious sedation is used, she should not drive, but instead arrange for someone to drive her home after the procedure.

Source: Medical Disability Advisor



Prognosis

The predicted outcome after a D&C procedure is good and after-effects are minimal. A few individuals may experience menstrual-like cramping for a day or so following the procedure, and light cramping, mild bleeding, and minor vaginal discharge may continue for up to 2 weeks ("Dilation and Sharp Curettage"). Most individuals recover with no problems associated with the anesthesia or the procedure.

In general, D&Cs are successful in evaluating and treating abnormal uterine bleeding and in providing a diagnostic tool in addition to ultrasonography, hysteroscopy, and laparoscopy.

Source: Medical Disability Advisor



Specialists

  • Family Physician
  • Gynecologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Heart disorders
  • Kidney disorders
  • Liver disease
  • Lung disorder

Source: Medical Disability Advisor



Complications

Complications during the surgery are rare, affecting only 1.9% of individuals (Hefler). These include perforation of the uterus, excessive bleeding (hemorrhage), retained uterine tissues, infection, trauma to abdominal organs, and injury to the vagina or cervix. If the cervix is injured during the procedure, it may be unable to retain a fetus within the uterus (cervical incompetence) in future pregnancies, possibly resulting in a spontaneous abortion (miscarriage) or premature birth. Rarely, a condition known as Asherman's syndrome may occur, in which scar tissue (intrauterine adhesions) forms inside the uterus after a D&C, rendering the individual infertile. As with any procedure performed under anesthesia, possibilities exist for the individual to experience a reaction to the anesthesia or to have breathing problems.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability may be influenced by the underlying reason the procedure was performed (e.g., menorrhagia, incomplete abortion, miscarriage, or testing and diagnosis) and the development of complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are generally not required following a D&C procedure. Most women who undergo a D&C are able to return to work or to resume previous activities within a day or so with only minor restrictions, such as refraining from strenuous exercise and activity or driving on the day of the procedure. If pain medication is needed, company policy on medication usage should be reviewed to determine if medication use is compatible with job safety and function.

Source: Medical Disability Advisor



References

Cited

"Dilation and Sharp Curettage (D&C) for Abortion." WebMD.com. 29 Sep. 2008. WebMD, LLC. 13 Jul. 2009 <http://women.webmd.com/dilation-and-sharp-curettage-dc-for-abortion>.

"Special Procedures: Dilation and Curettage." ACOG: The American College of Obstetricians and Gynecologists. 2009. American College of Obstetricians and Gynecologists. 13 Jul. 2009 <http://www.acog.org/publications/patient_education/bp062.cfm>.

Hefler, L., et al. "The Intraoperative Complication Rate of Nonobstetric Dilation and Curettage." Obstetrics and Gynecology 113 6 (2009): 1268-1271. National Center for Biotechnology Information. National Library of Medicine. <http://www.ncbi.nlm.nih.gov/pubmed/19461421>.

Moses, Scott. "Suction Dilation and Curettage." Family Practice Notebook. 1 Jul. 2009. 13 Jul. 2009 <http://www.fpnotebook.com/OB/Procedure/SctnDltnAndCrtg.htm>.

Source: Medical Disability Advisor