DESCRIPTION OF OPERATION: The patient was consented and made aware of the risks and benefits of repeat low transverse cesarean delivery. She was taken to the operating theater and administered spinal anesthesia, which was found to be adequate. The patient was then placed in a supine position with a leftward tilt.
A Pfannenstiel incision was then made and carried down to the underlying fascia. The underlying fascia was nicked to the midline and muscle was visualized. The fascia was picked up with pickups and extended out lateral with Mayo scissors. The inferior portion of the fascia was grasped with Kocher clamps, tented up and the muscle was dissected off bluntly.
In a similar fashion, the superior aspect of the fascia was grasped with Kocher clamps, tented up, and dissected off bluntly. The defect was carried to the midline and the peritoneum was identified and entered sharply with Metzenbaum scissors. The peritoneal defect was then extended inferiorly and superiorly with blunt stretching.
The bladder blade was placed and the bladder flap was identified and grasped with pickups and the bladder flap was entered sharply with the Metzenbaum scissors. The bladder flap incision was extended out laterally and the bladder flap was created digitally. The bladder blade was reinserted below and the uterine segment was identified.
The lower uterine segment was scored and defect was created in the midline. The uterine incision was extended bluntly. At the time of delivery, several attempts were made to deliver the infant’s head.
A vacuum was used for additional traction to remove the infant’s head. It took only one application and minimal force to remove the infant. Following removal of the infant, the cord was clamped and cut and cord blood was collected. The placenta was extracted manually.
Attention was then turned to the uterus. The uterus was repaired with 0 Vicryl in a running locking fashion. The gutters were cleared of all clots and debris and irrigation was used. Following that, the uterus was placed back into the abdomen and the uterine incision was visualized one more time and was found to be hemostatic.
The fascia was repaired with 0 PDS in a running fashion. The subcuticular layer was reapproximated with 3-0 Vicryl. The skin was closed with staples. Sponge, lap, and needle counts were correct x2, and 2 grams of Ancef was given at the time of cord clamp. The patient tolerated the procedure quite well and was sent to the PACU.
