DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. A 39 and 3/7 weeks’ intrauterine pregnancy, in labor.
2. Fetal intolerance to labor.
3. Failure to progress.
POSTOPERATIVE DIAGNOSES:
1. A 39 and 3/7 weeks’ intrauterine pregnancy, in labor.
2. Fetal intolerance to labor.
3. Failure to progress.
OPERATION PERFORMED: Primary low transverse cesarean section.
ANESTHESIA: Epidural.
ESTIMATED BLOOD LOSS: 1100 mL.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gravida 1, para 0 who presents at 39 and 3/7 weeks in labor. The patient progressed to 4 cm dilated, 80% effaced, and -2 station. After 4 hours, there was minimal change in vaginal examination, and Pitocin was commenced. The fetus had severe variable decelerations and a prolonged deceleration to the 90s for approximately 8 minutes with no further change in cervix. It was decided at this time to perform a primary cesarean section.
OPERATIVE FINDINGS:
1. Viable female infant, Apgars 8 and 9, weight 3842 grams.
2. A tight nuchal cord x1.
3. Persistent occiput posterior position.
DESCRIPTION OF OPERATION: The patient was taken to the operating room where the epidural was redosed and felt to be adequate. The patient was then prepped and draped in the normal sterile fashion in the dorsal supine position with a leftward tilt.
A Pfannenstiel skin incision was made with a scalpel and carried down through the underlying layer of fascia with the scalpel. The fascia was nicked in the midline, and a fascial incision was extended laterally with the Mayo scissors. The inferior aspect of this incision was then grasped with two Kocher clamps, tented up, and the underlying rectus muscles dissected off with the Mayo scissors. A similar procedure was performed on the superior aspect of this incision.
The rectus muscles were then separated in the midline and the peritoneum identified and entered sharply with the Metzenbaum scissors. This incision was extended superiorly and inferiorly with good visualization of the bladder. A bladder blade was inserted, and the vesicouterine peritoneum was incised in a transverse fashion. A bladder flap was created digitally. The bladder blade was repositioned, and the lower uterine segment was incised in a transverse fashion with a scalpel.
Upon entrance into the endometrial cavity, this incision was extended bluntly. The head was then delivered atraumatically, and nuchal cord was reduced, the mouth and nose were suctioned with bulb suction, and the remainder of the infant was delivered without difficulty. The cord was then doubly clamped and cut and the infant handed off to the awaiting nursery staff. Cord blood was then obtained and the placenta was delivered with fundal pressure. The uterus was then exteriorized and wrapped with a wet laparotomy sponge. The uterine cavity was then wiped out with a wet laparotomy sponge.
The uterus incision was then reapproximated with a running interlocking fascia with 0 Vicryl, a second layer of the same suture was used to imbricate the first layer, and there was noted to be excellent hemostasis. The uterus was then returned to the peritoneal placement and gutters cleared of all clots and debris with wet laparotomy sponges. The peritoneum was then reapproximated in a running fashion with 2-0 Vicryl. The fascia was closed in a running fashion with 0 Vicryl, the subcutaneous fat was then irrigated, all bleeders coagulated. The subcutaneous fat was then reapproximated in a running fashion with 3-0 Vicryl, and the skin was closed with staples. The patient tolerated the procedure well and was taken to the recovery room in good condition.
