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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.

Threatened Abortion


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
640.00 - Hemorrhage in Early Pregnancy, Threatened Abortion, Unspecified as to Episode of Care or not Applicable
640.01 - Hemorrhage in Early Pregnancy, Threatened Abortion, Delivered, with or without Mention of Antepartum Condition
640.03 - Hemorrhage in Early Pregnancy, Threatened Abortion, Antepartum Condition or Complication

Related Terms

  • Threatened Miscarriage
  • Uterine Bleeding in Pregnancy

Overview

Threatened abortion is a condition in pregnancy before the twentieth week of gestation characterized by uterine bleeding and cramping while the opening of the uterus (cervix) is closed. Threatened abortion may progress to spontaneous incomplete or complete abortion. Spontaneous abortion, or miscarriage, is defined as the naturally occurring delivery or loss of the products of conception before the twentieth week of pregnancy without induction or instrumentation.

Often the reason for light bleeding during pregnancy or threatened abortion is unclear.

Abnormalities in the developing fetus account for up to 90% of first-trimester miscarriages (Gaufberg).

Incidence and Prevalence: Threatened abortion occurs in about 20% to 30% of pregnancies, although only 50% of threatened abortions actually lead to miscarriage (Porter). Thus, incidence of miscarriage is about 5% to 15% of all recognized pregnancies (Gaufberg).

An estimated 600,000 to 800,000 miscarriages occur each year in the US (Bowles).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The risk of fetal chromosomal abnormalities that may lead to spontaneous abortion increases with maternal age (Gaufberg).

The risk of threatened abortion is increased in women who have experienced a previous miscarriage (Bhattacharya).

Other risk factors associated with threatened abortion include comorbid maternal diseases such as diabetes mellitus, hypothyroidism, epilepsy, severe hypertension, kidney infection (pyelonephritis), and other infections; genital tract abnormalities of the cervix or uterus (such as a divided or septate uterus); drug and alcohol abuse; excessive smoking; physical injury; malnutrition; and severe emotional shock.

Source: Medical Disability Advisor



Diagnosis

History: Women report a bloody discharge from the uterus, lower back pain, and sometimes cramping, often over a period of several days. Cramping, which may not always be present, can signal the onset of a miscarriage. Women should report the onset of bleeding, amount of blood passed, onset of abdominal pain, and history of previous miscarriage.

Physical exam: A pelvic examination is done to check if the opening to the uterus (cervix) is open or closed, to look for evidence of other conditions that may cause bleeding, and to determine if the amniotic sac has ruptured. The examiner also will gently feel (palpate) the abdomen to check for tenderness or distension that may indicate hemorrhage within the peritoneum.

Tests: A pregnancy blood test and ultrasound may be done to determine if the embryo or fetus is still present and alive and to rule out ectopic pregnancy. Ultrasound using a vaginal probe (transvaginal pelvic ultrasonography) produces more accurate results than transabdominal ultrasound. A complete blood count (CBC) is done to look for infection. Blood typing and Rh testing are performed. Serum human chorionic gonadotropin levels are also measured. Tests may be done to determine the level of progesterone, a hormone crucial for maintaining pregnancy. Studies of progesterone are rarely done with the first threatened abortion.

Source: Medical Disability Advisor



Treatment

Many physicians recommend modified bed rest and abstinence from sexual intercourse until the bleeding has stopped, although there is some debate about whether bed rest improves the outcome of threatened abortion. If progesterone levels are low, the woman may be treated with supplemental hormone to help maintain the pregnancy; however, there is no firm evidence that hormone therapy is useful (Vorvick). Comorbid maternal diseases such as diabetes mellitus and hypothyroidism and infections should be treated appropriately. Exposure to environmental toxins, alcohol, and street drugs should be stopped.

Women with repeated spontaneous abortion due to an alloimmune cause (antibody production against fetal Rh factor) may be treated with immunotherapy using paternal lymphocytes. When the cause of reproductive failure is the presence of antiphospholipid antibodies in the woman's blood (commonly occurring in individuals with lupus), administration of heparin with low doses of aspirin may maintain the pregnancy; however, this type of medical treatment should be individualized according to the underlying condition.

When threatened abortion proceeds to miscarriage, trauma-focused interventions can help individuals better understand the event, recognize and accept the traumatic experience, and go on with their lives. A physician trained in critical incident stress debriefing (CISD) may help individuals cope. CISD involves a 7-stage process by which the individual describes the event, identifies the most traumatic aspects of it, is educated about normal reactions and coping mechanisms, clarifies ambiguities, and prepares for termination of the event.

Source: Medical Disability Advisor



Prognosis

If there is no dilation of the cervix, the symptoms may subside and the pregnancy may go to term. If the fetus is still alive and its attachment to the uterus has not been interrupted despite uterine bleeding and cramping, the pregnancy may continue.

Threatened abortion may progress to profuse or prolonged vaginal bleeding, and the cervix may become thinned (effaced) or open (dilated), resulting in a spontaneous abortion. A complete abortion occurs when the entire contents of the uterus are delivered. An incomplete abortion occurs when the uterus is not entirely emptied of its contents. A missed abortion occurs when the fetus dies but is not immediately expelled. Any of these conditions may result in acute stress disorder (ASD) as a consequence of exposure to a traumatic event that arouses intense negative emotions in the person involved; anxiety and depression may continue up to 1 year following a spontaneous abortion (Griebel). However, most women who experience a spontaneous abortion are able to carry a fetus to term on subsequent pregnancies. Less than 1% of women have repeated (3 or more) miscarriages (Stenchever 429).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Gynecologist
  • Obstetrician/Gynecologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Immune system disorders
  • Psychiatric disorders

Source: Medical Disability Advisor



Complications

Bleeding may be massive (hemorrhage) and produce anemia or shock. Infection is a possible complication. Psychological complications such as anxiety or depression may occur. Women with threatened abortion in the first trimester of pregnancy are at a higher risk for obstetric complications at and around labor and delivery (e.g. pre-birth hemorrhage, preterm delivery, malpresented fetus, cesarean section, and manual removal of the placenta following delivery) (Wijesiriwardana).

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that might influence duration of disability include the presence of underlying conditions, individual’s response to treatment, and presence of complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Return to work may be delayed if heavy work and lifting is required. Frequent rest periods and light work activities may be required. Regular prenatal visits to a physician or maternity clinic are essential for a safe, healthy pregnancy, delivery, and postpartum period.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • When did bleeding begin, and how much blood was passed?
  • Does individual have abdominal pain? Cramping?
  • Was the diagnosis confirmed by pelvic exam, ultrasound, and blood tests?
  • Did pelvic exam determine whether the opening to the uterus (cervix) is open or closed, or if there is evidence of other conditions that may cause bleeding?
  • Were a pregnancy blood test and ultrasound done to determine if the fetus is still present and alive?
  • Were levels of pregnancy hormones evaluated?
  • Were maternal causative factors treated appropriately?
  • Does individual have a history of miscarriage(s)?
  • Were surgical procedures performed for uterine abnormalities prior to the pregnancy?

Regarding treatment:

  • Has individual remained on bed rest for an appropriate period?
  • Have any underlying disorders such as diabetes and hormone deficiencies been treated?
  • Is individual exposed to environmental toxins? Has individual been removed from exposure?
  • Has individual experienced repeated, unexplained spontaneous abortions?
  • Does individual have antiphospholipid antibodies in her blood?
  • Would she and the fetus benefit from corticosteroid and low-dose aspirin therapy?
  • Was a hysteroscopic resection or removal of a leiomyoma required?

Regarding prognosis:

  • Was individual able to maintain the pregnancy?
  • Did individual have a partial, complete, or missed abortion?
  • If the pregnancy has ended, has psychological counseling been made available?
  • Has individual experienced a significant loss of blood?
  • If individual is anemic, did she go into shock from loss of blood?

Source: Medical Disability Advisor



References

Cited

Bhattacharya, S., et al. "Does Miscarriage in an Initial Pregnancy Lead to Adverse Obstetric and Perinatal Outcomes in the Next Continuing Pregnancy?" BJOG: An International Journal of Obstetrics and Gynaecology 115 13 (2008): 1623-1629. PubMed. <PMID: 18947339>.

Bowles, Stephen V., et al. "Acute and Post-traumatic Stress Disorder After Spontaneous Abortion." American Academy of Family Physicians. 16 Jul. 2009 <http://www.aafp.org/afp/20000315/1689.html>.

Gaufberg, Slava M. "Threatened Abortion." eMedicine. Eds. Roy Alson, et al. 17 Dec. 2008. Medscape. 31 Aug. 2009 <http://emedicine.medscape.com/article/795439-overview>.

Griebel, C. P., et al. "Management of Spontaneous Abortion." American Family Physician 72 (2005): 1243-1250. American Family Physician. American Academy of Family Physicians (AAFP). 16 Jul. 2009 <http://www.aafp.org/afp/20051001/1243.html>.

Porter, Robert S., ed. "Spontaneous Abortion." Merck. Ed. Robert S. Porter. Nov. 2005. Merck & Co., Inc. 9 Nov. 2009 <http://www.merck.com/mmpe/sec18/ch263/ch263l.html>.

Stenchever, Morton. Comprehensive Gynecology. 4th ed. St. Louis: Mosby, Inc., 2001.

Vorvick, Linda, and David Zieve. "Miscarriage—Threatened." MedlinePlus. 3 Feb. 2009. National Library of Medicine. 28 Aug. 2009 <http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000907.htm>.

Wijesiriwardana, A., et al. "Obstetric Outcome in Women with Threatened Miscarriage in the First Trimester." Obstetrics and Gynecology 107 3 (2006): 557-562. PubMed. <PMID: 16507924>.

Source: Medical Disability Advisor