C-Section — full op note

Body

OPERATIVE FINDINGS: *** intra-abdominal adhesions were noted. The uterus, tubes, and ovaries bilaterally were*** normal. The amniotic fluid was ***. A *** infant was delivered in *** presentation. Neonate had apgars of *** and ***, weight *** g.

OPERATIVE REPORT: The risks, benefits and alternatives of the procedure were discussed with the patient and informed consent obtained before proceeding to the operating room. Once in the operating room, the patient was administered neuraxial anesthesia and placed in the dorsal supine position with leftward table tilt. ***Patient had neuraxial anesthesia anesthesia prior to entering the operating room. She was placed in the dorsal supine position with leftward table tilt.*** Fetal heart tones were obtained prior to the procedure. The patient was then prepped and draped in the normal sterile fashion.

Once anesthesia was tested and found to be adequate, a Pfannenstiel skin incision was made with scalpel and carried down to the level of the fascia with electrocautery***. The fascia was incised with a scalpel and the incision extended bilaterally with Mayo scissors. The superior aspect of this incision was grasped with Kocher clamps, elevated upward, and the underlying rectus muscles dissected away bluntly and then sharply with the scalpel***. Attention was then turned to the inferior aspect of this incision, which was grasped with Kocher clamps, elevated upward, and the underlying pyramidalis muscles dissected away bluntly and then sharply with Mayo scissors***. The rectus muscles were separated in the midline and the peritoneum entered bluntly. The peritoneum was stretched bluntly after ensuring no immediate intraabdominal adhesions.

Sharp entry: The rectus muscles were separated in the midline. An area of clear peritoneum was identified, opened with Metzenbaum scissors, and carefully dissected with electrocautery.***

Bladder flap: The vesicouterine reflection was grasped with smooth pickups, incised with Metzenbaum scissors, and the incision extended bilaterally. The inferior aspect of this incision was grasped with smooth pick ups and the bladder flap developed bluntly. The bladder blade was replaced into the newly created bladder flap and the uterine incision was made with scalpel in a low transverse manner. The incision was stretched bluntly.***

The bladder blade was then placed and the uterine incision was made with scalpel in a low transverse manner. The incision was stretched bluntly.

The fetus was noted to be in the *** presentation. The infant was then elevated to the level of the hysterotomy and delivered atraumatically in the standard fashion. The umbilical cord was clamped twice and cut and the neonate handed off to the awaiting pediatricians for resuscitation. The placenta was removed with the assistance of fundal massage. The uterus was exteriorized, wrapped in wet lap sponge, and the interior swept of all clots and debris with a dry lap sponge. The hysterotomy was then closed with 1-0 Biosyn in a running, locked fashion. ***A second imbricating layer of the same suture was then used to reinforce the hysterotomy repair.***

The hysterotomy was inspected and *** hemostasis was noted. The uterus was returned to the abdomen and the abdomen irrigated using moist lap sponges. Inspection of the hysterotomy again revealed excellent hemostasis. The undersides of the fascia were inspected, as were the rectus muscles, and were all found to be hemostatic. The fascia was then closed with 0 Vicryl/1-Maxon*** in a running fashion. The subcutaneous space was irrigated using a moist lap sponge and hemostasis was achieved with judicious use of electrocautery. The subcutaneous space was then reapproximated *** running continuous sutures of 2-0 Velosorb. The skin was closed with 4-0 Biosyn in a subcuticular fashion. Steri-Strips and a sterile dressing were then applied.

***In situ repair: The fetus was noted to be in the *** presentation. The infant was then elevated to the level of the hysterotomy and delivered atraumatically in the standard fashion. The umbilical cord was clamped twice and cut and the neonate handed off to the awaiting pediatricians for resuscitation. The placenta was removed with the assistance of fundal massage and the interior of the uterus was swept of all clots and debris with a dry lap sponge. The hysterotomy was then closed with 1-0 Biosyn in a running, locked fashion with uterus in situ. ***A second imbricating layer of the same suture was then used to reinforce the hysterotomy repair. The abdomen irrigated using moist lap sponges.*** Inspection of the hysterotomy revealed excellent hemostasis. The undersides of the fascia were inspected, as were the rectus muscles, and were all found to be hemostatic. The fascia was then closed with 0 Vicryl/1-Maxon*** in a running fashion. The subcutaneous space was irrigated using a moist lap sponge and hemostasis was achieved with judicious use of electrocautery. The subcutaneous space was then reapproximated with ***running continuous sutures of 2-0 Velosorb. The skin was closed with 4-0 Biosyn in a subcuticular fashion. Steri-Strips and a sterile dressing were then applied. ***

The patient tolerated the procedure well, was taken to recovery in stable condition. At the end of procedure all lap, sponge, instrument and needle counts were correct x2.

VTE PROPHYLAXIS: SCDs

ANTIBIOTICS: Ancef *** g and Azithromycin 500 mg ***

Yellow *** markers = placeholders you fill in or delete per case.