Operation: Cesarean Section

Date: _______________
Surgeon: _______________
Assistant(s): _______________
Anesthesia: Spinal / epidural / GA
Anesthesiologist: Dr. _______________
PreOp Dx: _______________ (Failure to Progress, NRFHR, Breech, etc)
PostOp Dx: Same + live BB male/female
Operation: Low transverse cesarean section
Operative Findings: Thin anterior lower segment

Clinical Note: Ms. _______________ is a 25 year old G1 who presented to L&D on (date) in spontaneous labour at 38 weeks. She had oxytocin augmentation and progressed from 3 to 5 cm over 4 hours however there was no change in dilation over the following four hours. The vertex was at spines at minus 1 and OP/deflexed. Following discussion of the nature of cesarean section and possible complications consent was obtained.

Under (spinal/epidural/general) anaesthetic with a foley catheter inserted, the patient was prepped and draped in the usual sterile fashion in the supine position with a leftward tilt. A (Pfannensteil/midline) incision was made (through the patients previous incision). The incision was carried down to the fascia with (sharp dissection/cautery). The fascia was incised transversely and dissected off the rectus muscle using (blunt/sharp) dissection. Electrocautery was used for hemostasis. The peritoneum was opened taking care not to injure the bladder. The vesicouterine peritoneum was dissected off the lower uterine segment. The lower segment was assessed and a low transverse incision was made. The uterine incision was extended (bluntly/with bandage scissors).

The fetus was presenting as a (vertex/breech/transverse). The head was delivered without difficulty and the rest of the body followed easily.

Special: Breech Extraction

The fetal buttocks were palpated and delivered gradually through the hysterotomy. Fundal pressure was continued and both legs were extended using the pinard maneuver. With gentle pressure the legs and body gradually delivered. Once the scapula could be seen the baby was gently rotated and both arms were delivered using the loveseat maneuver. Maintaining head flexion in a modified Mariceau-smellie- veit maneuver the head was delivered without difficulty.

After one minute of delayed cord clamping, the cord was clamped twice and cut and the baby transferred to the warmer, awaiting the (nursing/pediatric) staff. Cord gases were then obtained. The placenta was then delivered (spontaneously/with assistance/manually). The uterus was explored and was empty of all tissue. (The uterus was exteriorized for better visualization). The uterine incision was then closed in (one/two layers) with (vicryl/chromic) suture. The first layer was locking and the second was imbricating. (One/two/three) (figure-of-eight/interrupted) sutures was required for good hemostasis. Tubes and ovaries were examined and appeared normal.

Special: Pomeroy Tubal Ligation

With the uterine closure complete and hemostasis achieved, attention was turned to the tubal ligation. A babcock clamp was used to grasp the left fallopian tube and the fimbriated end was confirmed prior to proceeding. A modified Pomeroy technique was completed by double tying using an 0 Vicryl on both sides of the babcock, then incising the fallopian tube between the two ties. The cut fallopian tube edges were then cauterized. Adequate hemostasis was noted. This tube was placed back in its anatomic position. The right fallopian tube was grasped and the same process was repeated, again being sure to identify the fibriated ends before proceeding.

(The peritoneum was closed with a running vicryl stitch). The fascia was closed by forming anchored knots with vicryl 2-0 at the lateral corners and suturing from one end to the other in a running unlocked fashion. The skin was then reapproximated with (staples/a running vicryl subcuticular suture).

At the end of the procedure all sponges, instruments, and sharps were counted and correct. Estimated blood loss was (500) ml. The patient (and baby) were taken to the recovery in stable condition. The (fe/male) baby weighed (3535) grams, and Apgars were (9) and (9) at 1 and 5 minutes respectively. Arterial and venous cord gases were (7.35 and 7.32) respectively.

[Describe any special consideration for the future (eg: as mentioned earlier, the lower segment was noted to be very thin. As such the patient has been advised that she should not labour in any future pregnancies and will require a repeat cesarean section).]