DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Term gestation.
2. Nonreassuring fetal condition with fetal bradycardia.
3. Placental abruption affecting approximately 50% of the placenta.
PROCEDURE PERFORMED: Crash low transverse cesarean section.
SURGEON: John Doe, MD
ANESTHESIA: Epidural anesthesia.
ESTIMATED BLOOD LOSS: 800 mL.
COMPLICATIONS: Hematuria.
DRAINS: A transurethral Foley was placed after the procedure.
PROCEDURE FINDINGS:
1. Normal pelvic anatomy.
2. Live male infant delivered at 0930 weighing 6 pounds 13 ounces, receiving Apgars of 3 at one minute and 6 at five minutes.
3. Placenta showing both organized and fresh blood on approximately 50% of the maternal side.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room with a functional epidural in place after four pushes resulting in a fetal bradycardia. Once the patient was on the operating room table, attempts were made to find fetal heart tones; however, none could be found. For this reason, instead of electing to perform a forceps delivery since the patient did not have a proven pelvis, we elected to proceed with a crash cesarean section due to the urgency and uncertainty of the baby’s condition. Attempts were made to place a Foley catheter, which had been removed just prior to starting to push. It was noted at that time there was already a small amount of blood in the urine. The patient’s abdomen was quickly prepped and the patient was draped. A skin incision was made with a knife and taken sharply down to the level of the fascia, which was extended manually. The rectus muscles were separated manually and the underlying parietal peritoneum was entered manually. A bladder blade was placed. The uterine incision was made above the reflection of the bladder peritoneum on the anterior uterine wall and extended manually. The infant was delivered from a vertex presentation. The cord was doubly clamped and cut. The infant was passed off to the awaiting neonatologist for further assessment. A sample of cord was obtained for cord gases. Cord blood was obtained. The placenta was manually extracted. The uterus was exteriorized, all clot and debris wiped from the endometrial cavity. The uterine incision was closed using 0 Monocryl in a running fashion, a second layer was a running imbricating stitch. The uterus was easily made hemostatic and placed back in the abdominal cavity in its normal anatomic position. The gutters were explored, all clot and debris removed. The uterine incision was again inspected and found to be hemostatic. The rectus muscles were reapproximated with a single stitch of 0 Monocryl incorporating the underlying parietal peritoneum. The subfascial space was inspected and found to be hemostatic. The fascia was closed in a running fashion from angle to angle using 0 PDS. The subcutaneous tissue was reapproximated using 3-0 Vicryl suture in interrupted fashion. The skin was closed in subcuticular fashion using 4-0 Monocryl. Following the procedure, a Foley catheter was placed and blood-tinged urine was returned as was expected. The bladder was evaluated intraoperatively and there was no obvious injury; however, this will be monitored closely in the recovery area. At the end of the procedure, an x-ray was performed as there was no time for a count, which showed no evidence of a foreign body. The patient was taken to the recovery room for observation and the patient will be transferred to the floor when stable.
