DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Induction of labor.
2. Suspected macrosomia.
3. Small pelvis.
POSTOPERATIVE DIAGNOSES:
1. Macrosomia.
2. Contracted pelvis.
3. Decreased variability.
4. Decreased fetal movement.
5. History of preterm labor.
6. Failure to descend.
7. Failure to progress.
8. Persistent late decelerations.
OPERATION PERFORMED:
Primary cesarean section.
SURGEON: John Doe, MD
ANESTHESIA:
Epidural.
ESTIMATED BLOOD LOSS:
600 mL.
INDICATIONS FOR OPERATION:
This is a very pleasant (XX)-year-old female who has done well during the pregnancy. She did have some preterm labor and was on Brethine, which did arrest the contractions. She was having some contractions on her own. She noticed decreased fetal movement recently.
She had a contraction stress test that was equivocal, and due to the fact that she was 3 cm with an equivocal contraction stress test and history of decreased fetal movement and also decreased variability, she was admitted for induction of labor. She received Pitocin.
She did have some episodes during the Pitocin induction where she did have some decelerations; they were not chronic or deep and they responded well when the Pitocin was turned off.
After the Pitocin would be running, after a while, she would begin to see other episodes of decelerations, and finally after enough episodes and enough persistent decelerations combined with failure to descend and failure to progress, she never got past 8 cm and -2, she was taken for primary cesarean section with her epidural anesthetic.
DESCRIPTION OF OPERATION:
After the epidural was fortified, in the supine position, a small incision was made in the suprapubic region and was extended to open subcutaneous with the Bovie and extended in both directions. We coagulated the bleeders that were encountered.
The muscle was separated in the usual fashion. Peritoneum was opened with pickups and Metzenbaum scissors and extended laterally in both directions. The bladder blade was placed. The bladder reflection was developed.
Uterine incision was made and then we noticed there was a very large vein running across the lower uterus. The uterine incision was made and then opened with the hemostat. It was then extended digitally. What fluid was left was clear.
Baby was delivered through the incision and found to have some caput and also the baby had the cord loosely around the neck and loosely around the left leg. The baby was delivered, cried immediately and the cord was clamped and cut after the baby was suctioned. The baby was shown briefly to the parents and then the baby was handed off to the neonatologist in attendance.
The cord blood was taken. The placenta was manually removed. The uterus was explored. Ring forceps were placed on the corners of the uterus and an Allis was placed at one end.
The bladder blade was reinserted. Uterus was closed in 2 layers with a 1 chromic suture, the first layer being interlocking. Some interrupted 1 chromic sutures were placed. Bovie was used for some superficial bleeders.
After the uterus was closed and good hemostasis was obtained, we copiously irrigated the pelvis. After doing the irrigation, we went ahead and checked the bladder, which was left to spontaneously heal. We then closed the muscle with a running 2-0 Vicryl suture. The fascia was closed with 0 Maxon from one end to the midline and from the other end to the midline. Subcutaneous was irrigated.
A subcuticular 4-0 Monocryl was used to close the skin as well as Steri-Strips. A pressure dressing was applied. Clots were expelled from the uterus. Mother was doing well at the end of the primary cesarean section. The patient was then sent to the recovery room in satisfactory condition.
