Primary low-flap cesarean section

PREOPERATIVE DIAGNOSIS:  Failure of descent.

POSTOPERATIVE DIAGNOSIS:  Failure of descent.

PROCEDURE:  Primary low-flap cesarean section.

COMPLICATIONS:  None.

ESTIMATED BLOOD LOSS:  100 cc.

FINDINGS:  A live male infant with Apgars of 9 and 9, with a weight of 8 pounds and 1 ounce.  There was moderate meconium.  There were normal tubes and ovaries bilaterally.

PROCEDURE IN DETAIL:  The patient was brought to the operating room and anesthesia was obtained without difficulty.  She was prepped and draped in a normal sterile fashion in a dorsal supine position with a leftward tilt.  A Pfannenstiel skin incision was then made with the scalpel and carried through the underlying layer of fascia with blunt and sharp dissection.  The fascia was nicked in the midline and the incision was extended laterally with the curved Mayo scissors.  Inferior aspect of the fascial incision was grasped with a Kocher clamp and elevated off the rectus muscles.  Rectus muscles were dissected out bluntly and sharply.  Attention was turned to the superior aspect, which in a similar fascia was dissected out bluntly and sharply.  The rectus muscles were separated in the midline.  The peritoneum was entered sharply and incision was extended superiorly and inferiorly with good visualization of the bladder.  Bladder blade was inserted.  The vesicouterine peritoneum was incised in a transverse fashion.  The scalpel was used to make the uterine incision and this was extended laterally with the bandage scissors.  A live male infant was delivered atraumatically.  The nose and mouth were suctioned on the field.  The cord was clamped and cut and the infant was handed to pediatrician with an Apgars of 9 and 9.  The baby weighed 8 pounds and 1 ounce.  There was moderate meconium.  Placenta was delivered spontaneously.  Uterus was cleared of all clots and debris, and the incision was closed with 0 chromic in a continuous locking fashion.  One figure-of-eight suture was placed in the midline for hemostasis.  The incision was re-inspected and noted to be hemostatic.  The tubes and ovaries were normal bilaterally, and the gutters were cleared of all the clots and debris.  The fascia was then closed with 1-0 Vicryl in a continuous fashion.  Subcutaneous tissue was irrigated, Bovie cautery was used for hemostasis, and the skin was closed with staples.