DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Term gestation.
2. Prior cesarean section.
3. Spontaneous rupture of membranes with active labor.
POSTOPERATIVE DIAGNOSES:
1. Term gestation.
2. Prior cesarean section.
3. Spontaneous rupture of membranes with active labor.
OPERATION PERFORMED:
Repeat low transverse cesarean section.
SURGEON: John Doe, MD
ANESTHESIA: Spinal.
ESTIMATED BLOOD LOSS: 800 mL.
FINDINGS: A viable female weighing 3325 grams with Apgars of 7 and 9.
COMPLICATIONS: None.
DISPOSITION: Stable.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was brought back to the operative suite, where adequate spinal anesthesia was obtained. The patient was then placed in the dorsal supine position and prepped and draped in a sterile fashion. A repeat Pfannenstiel skin incision was made with a blade and carried down to the subcutaneous tissues to the fascia, which was extended in the transverse fascia with Mayo scissors. The fascial incision was then dissected off the rectus muscle both bluntly and sharply. The rectus muscle was separated in the midline.
The peritoneum was entered bluntly. The peritoneum was then extended both superiorly and inferiorly with good visualization of the underlying bowel and bladder. The bladder blade was placed and a low transverse bladder flap was created in the vesicouterine fascia. This was created digitally and the bladder blade replaced. A low transverse uterine incision was made with the blade and carried down to the layers of uterus until membranes bulged at the incision. The incision was then extended in a transverse fashion digitally.
Hand was placed inside the pelvis and the head was brought up out of the pelvis and delivered atraumatically with gentle fundal pressure. Mouth and nares were bulb suctioned. The remainder of the infant was delivered. The cord was doubly clamped and cut and cord blood obtained. The infant was passed to the awaiting nursing staff in stable condition.
The placenta was then manually extracted and the uterus exteriorized. Uterine incision was readily identified and closed in two layers with 0 Vicryl, first in running locking followed by second imbricating layer. The bladder flap was then reapproximated with 2-0 Vicryl in a running fashion. The bilateral adnexa were within normal limits.
The uterus was placed back inside the pelvis and copious irrigation and reinspection of the incision was satisfactory. The peritoneum was reapproximated with 2-0 Vicryl in a standard fashion. Fascia was closed with 1 Vicryl from one angle to the next in a running fashion. Subcutaneous tissues were copiously irrigated. The skin was reapproximated with surgical staples and incision was cleaned and dressed appropriately. The uterus with expressed of remaining clot.
The patient tolerated the procedure well and was transported to the recovery room in stable condition.
