SAMPLE 2
O'CONNOR HOSPITAL
DUNG V. CAI, M.D.
REPEAT CESAREAN SECTION
_________________________________________________________________
ASSISTANT:
ANESTHESIOLOGIST:
VIOLETTA FARYNO, M.D.
LAWRENCE YEE, M.D.
PREOPERATIVE DIAGNOSIS: Gravida 9, para 6-0-2-4, 36 weeks and 1
day pregnancy with previous cesarean section and in labor.
POSTOPERATIVE DIAGNOSIS: Gravida 9, para 6-0-2-4, 36 weeks and 1
day pregnancy with previous cesarean section and in labor.
OPERATION:
ANESTHESIA:
Repeat low transverse cesarean section delivery.
Spinal.
INDICATIONS: The patient is a 32-year-old Hispanic woman, who is
gravida 9, para 6-0-2-4. The patient had prenatal examination at
the Valley Medical Center and went to the emergency room in labor
and rupture of membranes more than 24 hours. The hemoglobin on
admission was 10.2. The patient was having contractions every
five to six minutes. The cervix was 3 cm dilated, about 70%
effacement, and at -2 station.
The patient would like to have a repeat cesarean section
delivery.
PROCEDURE: The patient was brought to the operating room. The
spinal anesthesia was given. A Foley was inserted into the
bladder. The abdomen was prepped with Betadine. The abdomen was
draped.
A midline vertical incision was made along with the scar through
the skin, subcutaneous tissue, rectus fascia and the peritoneum
was opened up and down. The lower uterine segment was exposed
with the bladder retractor. The peritoneum of the lower segment
was cut with the Metzenbaum scissors. Then the lower uterine
segment was cut with the knife transversely. The head of the
baby was delivered. The baby is a baby girl with good Apgar
scores of 8 and 9.
Cord was clamped and cut. The baby was
handed to the neonatologist. The baby's weight later was 5
pounds, 6.5 ounces. The placenta was fundal and was manually
removed.
The uterine cavity was cleaned with wet lap pads. The uterine
incision was closed in layers. The first layer was closed with
#0 chromic catgut continuously. The second layer was closed also
with #0 chromic catgut on top of the first layer and the
peritoneum. The lower uterine segment was very thin. Both
ovaries were within normal limits. The pelvic cavity was
irrigated with saline and was suctioned until dry. The uterine
incision was dry. The sponge, instrument and needle counts were
correct. The abdominal incision was closed in layers. The
peritoneum was closed with #2-0 Vicryl continuously. The rectus
fascia was closed with 0 Vicryl continuously. The subcutaneous
tissue was closed with #2-0 chromic catgut in interrupted
stitches times four. The skin was approximated with retention
sutures, using 0 Vicryl. Staples were applied on the incision.
A dry dressing was applied on the incision.
The patient had 2 grams of ampicillin given around an hour before
the cesarean section.
ESTIMATED BLOOD LOSS:
About 500 cc.
The blood in the vagina was removed.
The patient was brought back to the recovery room in satisfactory
condition.