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.

Uterus, Perforation of


Related Terms

  • Damage to Uterus

Differential Diagnosis

Specialists

  • General Surgeon
  • Gynecologist
  • Obstetrician/Gynecologist
  • Radiologist
  • Urologist

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the size and cause of the perforation, treatment, the development of serious complications such as infection (sepsis), job demands, and the age and general health of the individual.

Medical Codes

ICD-9-CM:
621.8 - Disorders of Uterus, Other Specified, Not Elsewhere Classified
637.2 - Legally Unspecified Abortion Complicated by Damage to Pelvic Organs or Tissues
639.2 - Damage to Pelvic Organs and Tissues Following Abortion or Ectopic and Molar Pregnancies
867.4 - Injury to pelvic organs; Uterus, without mention of open wound into cavity
996.32 - Complications Peculiar to Certain Specified Procedures in the Use of Artificial Substitutes; Perforation of Uterus by IUD

Overview

Perforation of the uterus is an accidental puncture of the uterus.

Perforation is usually caused by a surgical instrument shaped like a spoon or scoop used for scraping and removing material from an organ (curette) or by an intrauterine device (IUD). There have been some cases of uterine perforation following induced abortion. The instrument penetrates through the uterine wall, and rarely, may migrate into the abdominal cavity where the bowel or bladder may also be perforated.

A woman's uterus can become perforated during other intrauterine procedures, such as rotating an infant during delivery using forceps, dilation and curettage (D&C) procedures in which the lining of the uterus is scraped, or during a tubal ligation sterilization procedure. During IUD insertion, perforations can occur when the uterus is abnormally positioned or unusually soft after a birth or abortion. An IUD can also become "lost" within the uterus, and the end of the device may pierce the muscular wall of the uterus.

Breastfeeding (lactating) women are at higher risk for perforation of the uterus during insertion of an IUD or with D&C and should be carefully monitored. During dilation and curettage procedures, postmenopausal women are at a higher risk for uterine perforation because the cervix narrows and the wall of the uterus become thinner after menopause.

Incidence and Prevalence: Uterine perforation occurs in about 1 out of every 250 (0.4%) abortion procedures; the perforation rate is higher when abortions are performed in the second trimester (Trupin).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who have had past abortions, C-sections, or other surgeries on the cervix have an increased risk for uterine perforation. The internal cervical os may become injured during these procedures, causing scar tissue formation and weakness of cervical tissues that may lead to increased susceptibility to perforation.

Source: Medical Disability Advisor



Diagnosis

History: The woman may report lower abdominal pain, heavy vaginal bleeding, or, if she has an IUD, failure to feel the IUD string. She may also report bloating, rigidity and pain in her abdomen, nausea, vomiting, chills, fever, and rapid heartbeat (tachycardia). However, some individuals may not report any symptoms (asymptomatic).

Physical exam: Pelvic examination may reveal heavy vaginal bleeding. Examination of the uterus may reveal a softened uterine wall due to birth or abortion. Abdominal distention may be evident upon examination by both palpation and auscultation.

Tests: Ultrasound (sonogram) is used to confirm the diagnosis. Blood tests such as a complete blood count (CBC) and sodium, potassium, and chloride (electrolytes) are drawn to detect presence of infection. Beta-human chorionic gonadotropin (B-hCG) assay, urinalysis, and coagulation studies are also helpful in the analysis of abortion complications. Radiological studies such as x-rays of the abdominal cavity can reveal blood or free air in the abdominal cavity. Laparoscopy or laparotomy may be done to confirm possible perforation.

Source: Medical Disability Advisor



Treatment

Treatment is based on the cause and extent of the perforation. If the perforation resulted from induced abortion procedures, surgical repair of the uterus may be indicated. If the bowel becomes perforated, a resection and surgical joining of the bowel segments (anastomosis) may be performed. If the perforation results from IUD use, removal of the IUD using an instrument to examine the abdominal cavity (laparoscope) is usually done, unless there is bowel perforation or severe infection (sepsis) present.

Broad-spectrum antibiotics are usually administered if symptoms of peritonitis or infection are present. Laparoscopy may be performed to examine the extent of the damage to the bladder, bowel, or uterus, and assess the need for surgical repair. Laparotomy may be needed if the perforation is difficult to repair, there is excessive hemorrhage, or the bladder and bowel have also been punctured.

Source: Medical Disability Advisor



Prognosis

If the cause of the perforation is known and treatment is promptly started, full recovery is expected. Surgical repair of damaged organs (repair of the uterus, anastomosis) and removal of the IUD are usually successful if there are no complications.

With immediate administration of a broad-spectrum antibiotic, infection usually subsides. If infection is left untreated, sepsis and death can occur.

Source: Medical Disability Advisor



Complications

Complications include inflammation of the abdominal lining (peritonitis), bowel or bladder injury, massive bleeding (hemorrhaging), and infection (sepsis). Adhesions and scar tissue can result from surgical repair of the uterus or other organs involved.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions on activities such as heavy lifting may be required if surgical repair has been performed.

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:

  • How did individual's uterus become perforated? IUD? Surgical procedure? Delivery? Induced abortion?
  • Is individual breastfeeding? Postmenopausal?
  • Does individual report lower abdominal pain, heavy vaginal bleeding, or, if she has an IUD, failure to feel the IUD string?
  • Does individual also report bloating, rigidity and pain in her abdomen, nausea, vomiting, chills, fever, and tachycardia?
  • Did pelvic examination reveal heavy vaginal bleeding? Is the uterine wall softened? Was abdominal distention evident?
  • Did individual have an ultrasound done? CBC and electrolytes? Abdominal x-rays?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was it necessary to repair the perforation surgically?
  • Was it necessary to also repair other organs?
  • If present, was an IUD removed?
  • Did individual develop peritonitis? Is the individual on antibiotics?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complications such as peritonitis, bowel or bladder injury, hemorrhaging, or sepsis? Does individual have adhesions or scar tissue?

Source: Medical Disability Advisor



References

Cited

Trupin, Suzanne R. "Abortion." eMedicine. Eds. Steven David Spandorfer, et al. 18 Oct. 2004. Medscape. 10 Jan. 2005 <http://emedicine.com/med/topic5.htm>.

Source: Medical Disability Advisor






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