DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. A 38 and 6 week intrauterine pregnancy.
2. History of previous cesarean section.
3. Active labor.
POSTOPERATIVE DIAGNOSES:
1. A 38 and 6 week intrauterine pregnancy.
2. History of previous cesarean section.
3. Active labor.
OPERATION PERFORMED: Repeat low transverse cesarean section.
SURGEON: John Doe, MD
ANESTHESIA: Spinal.
ANESTHESIOLOGIST: Jane Doe, MD
ESTIMATED BLOOD LOSS: 700 mL.
FLUIDS: 2900 mL of lactated Ringer’s.
URINE OUTPUT: 700 mL of clear urine.
COMPLICATIONS: None.
DISPOSITION: The patient was transferred to the recovery room.
OPERATIVE FINDINGS: A viable female infant, cephalic presentation, with clear fluid noted. Apgars were 8 and 9 at one and five minutes respectively with birth weight of 6 pounds 6 ounces. Uterus, tubes and ovaries were all noted to be within normal limits. The lower uterine segment was noted to be significantly thinned at the time of entrance into the abdominal cavity.
DESCRIPTION OF OPERATION: The patient was taken to the operating room where anesthesia was obtained without difficulty. She was then placed in the supine position with left lateral tilt and her abdomen was prepped and draped in the normal sterile fashion. A Foley catheter had been placed in the patient’s bladder prior to the procedure.
A Pfannenstiel skin incision was then made through the patient’s previous scar and carried down to the underlying layer of fascia. The fascia was nicked in the midline. The fascial incision was extended laterally with the use of Mayo scissors. The fascia was then elevated off the underlying rectus muscles through sharp and blunt dissection. The muscles were separated in the midline and the peritoneum was entered sharply. The peritoneal incision was then extended superiorly and inferiorly with good visualization of the bladder. The bladder blade was inserted and a bladder flap was created with pickups, tapes and Metzenbaum scissors. The bladder blade was then reinserted beneath the bladder flap. A low transverse incision was then made in the uterus and extended with bandage scissors. Clear fluid was obtained and the infant’s head was delivered without complication. The mouth and nose were suctioned with DeLee suction catheter. The cord was clamped and cut. The infant was handed off to the awaiting pediatricians.
The placenta was then delivered via uterine massage spontaneously. The uterus was exteriorized, cleared of all clots and debris and the uterine incision was closed in 2 layers using 0 chromic in a running locking fashion. The uterus was returned to the abdomen and copious irrigation was then performed. The uterine incision was reexamined and noted to be completely hemostatic.
The peritoneum was then reapproximated with 3-0 Vicryl in a running fashion. The fascia was reapproximated with 0-Vicryl in a running fashion. Subcuticular tissues were irrigated and bleeding points were controlled with Bovie in a subcuticular fashion using 4-0 Vicryl. The patient tolerated the procedure well. Sponge, lap, needle counts were correct x2. The patient was taken to the recovery room in stable condition.
