Operation: Dilation & Evacuation

Date: _______________
Surgeon: _______________
Assistants: _______________
Anethesia: General anesthesia with endotrachial tube
Anesthesiologist: _______________
Preop Diagnosis: Missed Abortion
PosOp Diagnosis: Same + removal of fetal tissue consistent with dates
Operative Findings: Small quantity of tissue in the vagina protruding from the os teased out with forceps followed by large tissue fragments removed with D&E.
Estimated Blood Loss: Less than 100 mL.
Complications: None.

Clinical Note: Ms. _______________ is a 32 year-old female who was identified as having a missed abortion on 1st trimester ultrasound during routine prenatal care. After discussion of the options for management, including expectant, medical management with misoprostol, and surgical management with a D&E, the patient elected for surgical management. Risks, potential complications, and benefits were discussed with Ms. _______________ and consent was signed prior to OR.

Procedure Note: Ms. _______________ was taken to the operating room and placed on the operating table in a supine position. After adequate anesthesia, the patient was placed in the dorsal lithotomy position. The vagina was prepped. The patient was then draped. A weighted speculum was then placed in the vagina to visualize the cervix. Previously mentioned products of conception were teased out with a ring forceps. The anterior lip of the cervix was then grasped with a tenaculum. Taking care not to enter deep into the uterus, a series of Hegar dilators were inserted sequentially into the cervical os up to a size of 9 mm. Next, with a 10-mm suction curette, multiple curettages were performed removing tissue which appeared appropriate in quantity and consistency with a 12-week pregnancy. A sharp curettage then was performed, followed by two repeat suction curettages. Once no further tissue could be removed, the procedure was terminated and the equipment was removed from the vagina. The cervix was carefully inspected once last time to ensure hemostasis from the the tenaculum site and that there was no significant hemorrgage from the os and then the weighted speculum was removed. The patient tolerated the procedure well. The patient's nlood type is Rh negative and therefore WinRho/Rhogam will be given post operatively prior to discharge.
Followup will be arranged for approximately two weeks from today.