Primary Low Transverse Cesarean Section Operative Sample Report
PREOPERATIVE DIAGNOSES:
1. 37 and 0 weeks’ estimated gestational age intrauterine pregnancy.
2. Frank breech presentation.
3. Biophysical profile 2/8, status post preterm premature rupture of membranes with nonreassuring fetal heart tracing.
POSTOPERATIVE DIAGNOSES:
1. 37 and 0 weeks’ estimated gestational age intrauterine pregnancy.
2. Frank breech presentation.
3. Biophysical profile 2/8, status post preterm premature rupture of membranes with nonreassuring fetal heart tracing.
PROCEDURES PERFORMED: Primary low transverse cesarean section via Pfannenstiel.
SURGEON: John Doe, MD
ANESTHESIA: Spinal.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 1000 mL.
FLUIDS: 2500 mL of LR.
URINE OUTPUT: 150 mL of clear urine at the end of the procedure.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old G1 who was admitted as a transfer from an outside hospital following preterm premature rupture of membranes. The patient underwent formal ultrasound and was found to have a biophysical profile of only 2/8 with 2 points being for amniotic fluid only. The patient was also found to have repetitive spontaneous decelerations on fetal heart tracing and was in frank breech presentation. For this reason, it was decided to proceed with cesarean section delivery.
FINDINGS: Male infant in frank breech presentation. No meconium was noted. Pediatrics present at delivery. Apgars 7 and 9. Weight 1762 grams. Normal uterus, tubes, and ovaries bilaterally.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room where her spinal anesthesia was placed and found to be adequate. She was then prepared and draped in the normal sterile fashion in the dorsal supine position with the leftward tilt. A Pfannenstiel skin incision was then made with the scalpel and carried through to the underlying layer of fascia. The fascia was incised in the midline, and the incision was extended laterally with the Mayo scissors. The inferior aspect of the fascial incision was grasped with Kocher clamps, elevated, and the underlying rectus muscles were dissected off bluntly and sharply using the Mayo scissors.
Attention was then turned to the superior aspect of the incision, which in a similar fashion was grasped, tented up with Kocher clamps, and the underlying rectus muscles dissected off bluntly and sharply using the Mayo scissors as well as the Bovie. The rectus muscles were then 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 bladder blade was then inserted, and the vesicouterine peritoneum was identified, grasped with the pickups, and entered sharply with the Metzenbaum scissors.
The incision was then extended laterally and the bladder flap was created digitally. The bladder blade was inserted and the lower uterine segment was incised in a transverse fashion with the scalpel. The uterine incision was extended laterally by manual stretching. The bladder blade was removed and the infant buttocks were delivered followed by legs, torso, arms, and finally head in a breech delivery fashion. Nose and mouth were suctioned. The cord was clamped and cut.
The infant was handed off to the awaiting pediatricians. Cord gases were sent. The placenta was removed manually. The uterus was exteriorized and cleared of all clots and debris. The uterine incision was repaired with 0 Vicryl in a running locked fashion. A second layer of the same suture was used to obtain excellent hemostasis. The uterus was returned to the abdomen. The gutters were cleared of all clots. The pelvis was irrigated with warm normal saline. The uterine defect was well visualized in normal anatomic position and was noted again to be hemostatic.
The peritoneum was then well identified and reapproximated with 3-0 Vicryl. The muscle was then noted to be hemostatic. The pyramidalis was then loosely reapproximated with 2 interrupted stitches. The fascia was then closed using 0 Vicryl in a running fashion. The subcutaneous tissues were then reapproximated using interrupted stitches of 3-0 Vicryl. The skin was then closed using staples. The patient tolerated the procedure well. Sponge, lap, and needle counts were correct x2. Ancef, 2 grams, was given at cord clamp. The patient was taken to the recovery room in stable condition.
