SAMPLE 4
O'CONNOR HOSPITAL
DUNG V. CAI, M.D.
CESAREAN SECTION
_________________________________________________________________
ASSISTANT:
ANESTHESIOLOGIST:
OPERATION:
WUN-YI TSAI, M.D.
CHRISTINE DOYLE, M.D.
Primary low transverse cesarean section delivery.
PREOPERATIVE DIAGNOSIS:
infant.
POSTOPERATIVE DIAGNOSES:
infant.
ANESTHESIA:
Arrest of progress, possible enlarged
Arrest of progress, possible enlarged
Epidural anesthesia.
INDICATIONS: This is a 32-year-old Vietnamese woman who has 41weeks and 1-day of pregnancy. The patient was admitted yesterday
morning for induction of labor because of 41-weeks of pregnancy.
The cervix was dilated to complete dilation, then the patient was
pushing for 3 hours. The abdomen seemed to be large. The head
was only at 0 station. The patient had epidural anesthesia. The
hemoglobin was 11.4.
The patient would like to have the cesarean section delivery and
when she needs blood, she can have blood from the blood bank.
The patient had positive GBS and had penicillin G IV every 4
hours. The first dose was at 5 M, then the subsequent dose was
2.5 M.
PROCEDURE: She was brought to the operating room. The epidural
anesthesia was given and the abdomen was prepped with Betadine
and then the Foley was inserted into the bladder. The patient
was draped and the patient had a low transverse cesarean section
delivery.
A Pfannenstiel incision about 10 cm wide and about two
fingerbreadths above the symphysis pubis, through the skin,
subcutaneous tissue and rectus fascia. The muscle was separated
from the midline, the peritoneum was opened up and down. The
lower uterine segment was exposed with a bladder retractor. The
peritoneum of the lower uterine segment was cut transversely with
the Metzenbaum scissors and then with the knife. The incision of
the uterus was extended laterally with bandage scissors. The
head of the baby was delivered, the entire body of the baby was
delivered, the cord was clamped and was cut, and the baby was
handed to Dr. Yau who was the neonatologist. The baby had a good
Apgar score of 8 and 9 and weighed later 7 lb 12 oz.
The cord blood was collected. The placenta was posterior and was
manually removed. The uterine cavity was cleaned with wet lap
pad. The uterus was brought out of the abdominal incision. The
tube and ovary were within normal limits. There were multiple
discolorations on the surface of the uterus. There was some
oozing of the blood from the discolorations.
The uterus was closed with #0 chromic catgut continuously. The
second layer was closed on the top of the first layer also using
#0 chromic catgut continuously. The peritoneum of the lower
uterine segment was approximated with #2-0 chromic catgut
continuously. The pelvic cavity was irrigated with saline and
was suctioned to dry. The uterus was put back in the pelvic
cavity. The left gutter and the right gutter were again
irrigated with saline and were suctioned to dry. The patient had
2 gm Cefotan given intravenously after delivery of the baby. The
sponge count, needle count, and instrument count were correct.
The abdominal wall was closed in layers. The peritoneum was
closed with #2-0 Vicryl continuously. The rectus muscle was
approximated with #0 chromic catgut in interrupted stitches. The
fascia was approximated with #0 Vicryl continuously. The
subcutaneous tissue was approximated with #3-0 plain in
interrupted stitches. The skin was approximated with staples.
The dry dressing was applied on the incision. The blood loss was
about 800 cc. The blood clots in the vagina were removed.
The urine output was good and the urine showed blood tinged.