Repeat Low Transverse Cesarean Section via Pfannenstiel Incision
DESCRIPTION OF OPERATION: After informed consent was obtained, the patient was taken to the operating room, where spinal anesthesia was placed and found to be adequate. The patient was then placed in dorsal supine position with leftward tilt. The patient was then prepped and draped in normal sterile surgical fashion.
A Pfannenstiel skin incision was then made with scalpel and carried through to the underlying layer of fascia. The fascia was incised in the midline.
Incision was extended laterally with the Mayo scissors. Superior aspect of the fascial incision was grasped with the Kocher clamp, elevated up, and the underlying rectus muscles dissected off bluntly.
Attention was then turned to the inferior aspect which in a similar fashion was grasped with the Kocher clamp, tented up, and the underlying rectus muscles dissected off bluntly. Rectus muscles were then separated in midline.
The peritoneum was identified, tented up, and entered sharply with Metzenbaum scissors. Peritoneal incision was then extended superiorly and inferiorly with good visualization of the bladder. Bladder blade was inserted.
At this point, extensive adhesions were noted between anterior abdominal wall and the anterior aspect of the uterus, especially on the right lateral and left lateral. The lower uterine segment was then incised in transverse fashion.
Incision was then extended laterally. The infant’s head was then delivered atraumatically. Nose and mouth were bulb suctioned. Infant’s shoulders and trunk were then delivered without complications. Cord was clamped and cut and the infant was handed off to the waiting pediatrician. Cord blood was sent, after which placenta was removed manually.
The uterus was exteriorized and cleared of all clots and debris. Uterine incision was repaired with an 0 Vicryl in a running fashion. Second layer was used in an imbricated fashion to obtain excellent hemostasis.
Several figure-of-eight sutures were also placed with 0 Vicryl to obtain excellent hemostasis, after which the uterus was returned to the abdomen. The gutters were cleared off all clots and debris.
The abdomen was irrigated with saline, excellent hemostasis was noted. The muscles were reapproximated with 2 Vicryl on both sides. Further muscles were cut on entry to the abdomen. The rectus muscles were cut on entry to the abdomen.
Excellent hemostasis was noted there. The fascia was then approximated with 0 Vicryl in a running fashion, excellent hemostasis was noted, and the skin was closed with staples. The patient tolerated the procedure well. All sponge, lap and needle counts were correct x2, and the patient was taken to the recovery room in stable condition.
