Cesarean Operative Note

 

Preoperative Diagnosis: *** year-old G***P*** at ***w***d with ***

Postoperative Diagnosis: Same

Comorbidities:

Procedure: *** Low-Transverse Cesarean Section via *** Pfannenstiel skin incision

Surgeon: ***

Assistant: ***

Anesthesia: *** epidural with bolus/spinal

EBL: *** cc

IVF: *** cc

Urine Output: *** via foley catheter

Complications: none

Specimens: cord blood, placenta, ***cord gases

Findings: Live fe/male infant delivered at ***  from *** position through *** fluid with Apgars *** at 1 min and *** at 5 min and weight ***. There was ***no nuchal cord. The placenta delivered via ***fundal massage and was noted to be intact with a 3-vessel cord. There was a normal appearing uterus, tubes and ovaries. ***No adhesive disease. The patient tolerated the procedure well, went to the recovery room in stable condition. Sponge, needle, and instrument counts were correct x 3. Sponge wand negative x 2.

Gases: ***

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DESCRIPTION OF PROCEDURE: The patient was taken to the Operating Room, intermittent compression devices were placed on her calves bilaterally and a foley catheter was inserted. She was then prepped and draped in the usual sterile fashion in the dorsal supine position with a leftward tilt. Patient was identified by name and DOB and a safety timeout was performed. Anesthesia was found to be adequate after the Allis test.

 

A Pfannenstiel skin incision was then made with a knife and carried down to the underlying layer of fascia. The fascia was incised in the midline and the incision was extended laterally with Mayo scissors. Two Kocher clamps were then placed on the superior aspect of the fascial incision and the underlying rectus muscles were dissected off the fascia with a combination of blunt and sharp dissection.

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Attention was then turned to the inferior aspect of the fascial incision, which was grasped with two Kocher clamps and the underlying rectus muscles were dissected off with a combination of blunt and sharp dissection. The rectus muscles were separated in the midline. The peritoneum was identified, tented up, and entered bluntly. The peritoneal incision was extended superiorly and inferiorly with good visualization of the bladder.

 

*** The vesicouterine peritoneum was identified, grasped with pickups, and incised with the Metzenbaum scissors. The incision was extended laterally and a bladder flap was created digitally.

 

The bladder blade was inserted and a low transverse uterine incision was made with a knife. The incision was extended laterally bluntly.

 

The infant’s ***head was then delivered atraumatically with the shoulder and body following easily, ***no nuchal cord. The infant's nose and mouth were bulb suctioned and the cord was doubly clamped and cut after allowing the cord to pulsate x 30 seconds. The infant was handed off to a waiting pediatrician. Cord blood *** was collected.

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The placenta was then extracted with ***fundal massage intact with a three-vessel cord. The uterus was then exteriorized and cleared of all clots and debris. The hysterotomy was repaired with 0-Vicryl*** suture in a running, locked fashion. Good hemostasis was noted.

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Following this, the posterior cul de sac was cleared of all clots and debris and the uterus was easily returned to the abdomen. The paracolic gutters were then cleared of all clot and debris. The hysterotomy was again inspected, excellent hemostasis continued. The fascial incision was closed with 0 Vicryl in a running fashion. The subcuticular fat was then irrigated with normal sterile saline and reapproximated with 2-0 plain gut** and the skin was closed with 4-0 biosyn** in subcuticular fashion.

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The patient tolerated the procedure well and was taken to the Recovery Room in stable condition. Sponge, needle, and instrument counts were correct x 3.