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2025 ICD-10-CM code O62.1

Secondary uterine inertia; arrested active phase of labor; secondary hypotonic uterine dysfunction.

Codes from Chapter 15 (Pregnancy, childbirth and the puerperium) are exclusively for maternal records and should not be used for newborn records.The selection of the correct code within the O62 category (Abnormalities of forces of labor) is dependent on the specific type of uterine dysfunction.

Medical necessity for intervention is determined by the clinical picture. Secondary uterine inertia leading to prolonged labor, fetal distress, or maternal exhaustion warrants intervention, often including augmentation of labor or cesarean delivery. The lack of adequate contractions requires intervention to prevent harm to the mother or fetus.

Obstetrician-gynecologist (OB-GYN) or other qualified healthcare professional managing the labor and delivery.

IMPORTANT:Related codes include O62.0 (Primary inadequate contractions), O62.2 (Other uterine inertia), O62.3 (Precipitate labor), O62.4 (Hypertonic, incoordinate, and prolonged uterine contractions), and O62.8 (Other abnormalities of forces of labor).The choice of code will depend on the specific circumstances of the labor and delivery.

In simple words: Secondary uterine inertia means the contractions of the uterus during labor are not strong enough to push the baby out, even after labor has already started. This can make labor last longer and might lead to problems for the baby or require a C-section.

Secondary uterine inertia is a condition characterized by a failure of the uterine contractions to progress effectively after the onset of labor.This typically occurs after the active phase of labor has begun and is characterized by weak or infrequent uterine contractions that are insufficient to dilate the cervix and cause descent of the fetus.It can result in prolonged labor, fetal distress, and the need for intervention such as cesarean delivery.The term "secondary hypotonic uterine dysfunction" is often used synonymously.

Example 1: A 35-year-old G2P1 at 39 weeks gestation presents in active labor.After several hours, the labor progresses slowly and contractions become weak and infrequent, failing to achieve cervical dilation despite oxytocin augmentation.A diagnosis of secondary uterine inertia is made, and a cesarean section is performed., A 28-year-old G1P0 at 40 weeks gestation presents in labor. The active phase of labor is established, but after several hours of pushing, the cervix fails to fully dilate, and descent of the fetus is inadequate.The physician diagnoses secondary uterine inertia, and a vacuum-assisted delivery is attempted before opting for Cesarean section., A 40-year-old G3P2 at 37 weeks gestation is in active labor.After several hours, the contractions become weak and infrequent, leading to prolonged labor with fetal distress.The decision is made to perform a cesarean delivery due to secondary uterine inertia, and fetal well-being is prioritized.

Detailed documentation should include the timing and characteristics of uterine contractions (frequency, duration, intensity), cervical dilation and effacement over time, fetal heart rate monitoring, maternal vital signs, and the interventions performed (e.g., oxytocin augmentation, amniotomy, instrumental delivery, or cesarean section). The rationale for choosing O62.1 over other codes should also be explicitly documented.

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