DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Prior cesarean section.
2. Declines vaginal birth after cesarean.
3. A 39 weeks’ gestation.
POSTOPERATIVE DIAGNOSES:
1. Prior cesarean section.
2. Declines vaginal birth after cesarean.
3. A 39 weeks’ gestation.
OPERATION PERFORMED: Repeat low transverse C-section.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Spinal.
ESTIMATED BLOOD LOSS: 800 mL.
FINDINGS: A viable male weighing 4130 grams with Apgars of 6 and 9.
COMPLICATIONS: None.
DISPOSITION: Stable.
DESCRIPTION OF OPERATION: 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 the sterile fashion. A repeat Pfannenstiel skin incision was made with a blade and carried down through 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 muscles both bluntly and sharply. The rectus muscle was separated in the midline. The peritoneum was entered bluntly. The peritoneal incision was then extended both superiorly and inferiorly with good visualization of the underlying bowel and bladder. The bladder blade was placed, and the vesicouterine fascia was incised to create a bladder flap in a low transverse position. This was developed digitally.
A low transverse uterine incision was made with the blade and carried down through the layers of the uterus until membranes bulged through the incision. The uterine incision was then extended digitally. Hand was placed inside the pelvis, and the head was brought up out of the pelvis and delivered atraumatically with gentle fundal pressure. Prior to the head being delivered, actually through the skin, the sound of the baby starting to cry was noted. After the head was delivered, the mouth and nares were aggressively bulb suctioned. Remainder of the infant was delivered, and the infant was passed to the awaiting nursing staff for additional care. Cord was doubly clamped and cut and cord blood was obtained. The placenta was then manually extracted, and the uterus was exteriorized. The uterus was cleaned of remaining clot.
The uterine incision was readily identified and closed in two layers, first one with running locking followed by second imbricating layer of 0 Vicryl. The vesicouterine fascia was then reapproximated with 2-0 Vicryl. The adnexa were within normal limits. The uterus was placed back inside the pelvis. Copious irrigation and inspection of the incision was satisfactory. The peritoneum was then closed with 2-0 Vicryl in a running fashion. The fascia was closed with 1 Vicryl from one angle to the next. Subcutaneous tissues were copiously irrigated, and final bleeders were cauterized. The incision was then reapproximated with surgical staples in a standard fashion.
