Primary low transverse cesarean section

PREOPERATIVE DIAGNOSIS:                Voluntary.

POSTOPERATIVE DIAGNOSIS:             Voluntary.

PROCEDURE:                                             Primary low transverse cesarean section.

ANESTHESIA:                                             Epidural anesthesia.

COMPLICATIONS:                                     No complications.

EBL:                                                               500 mL.

FINDINGS:                                                    Beautiful baby boy, Apgars 9 and 9, weight 7 pounds.  Normal uterus, tubes, and ovaries.  Three-vessel cord, intact placenta.

PROCEDURE IN DETAIL:                        This is a 20-year-old gravida 1, para 0 at term.  The patient was being induced.  The patient progressed to 3 cm with adequate contractions with no further cervical dilatation.  Risks, benefits, and alternatives discussed with the patient at length, risks of morbidity and mortality of fetus, risks of morbidity and mortality to mother, including risks of hemorrhage, infection, injury to bowel, bladder, and ureters.  Risks were accepted.  The patient was taken to the operating room.  Epidural anesthesia was noted to be adequate.  She was prepped and draped in normal sterile fashion in supine position with leftward tilt.  Skin incision was made with scalpel, carried through to the underlying layer of fascia with Bovie.  Fascia was incised in midline, extended laterally.  Rectus muscle was dissected off bluntly.  Peritoneum was identified and entered.  Bladder flap created.  Uterine incision was made with a scalpel, extended laterally.  Baby was delivered from vertex presentation without complication.  Cord clamped and cut.  Bulb suctioned at the abdomen.  Baby handed off to the awaiting pediatrician.  Three-vessel cord was intact.  Placenta was delivered spontaneously.  Uterus exteriorized, cleared of all debris.  The incision was repaired with 1 Vicryl in running fashion.  A second layer was used to obtain hemostasis.  Uterus was returned to the abdomen.  The gutters were cleared of all clots.  The uterine incision was inspected and noted to be hemostatic.  The fascia was repaired with 1 Vicryl in a running fashion.  The skin was closed with staples.  The patient tolerated the procedure well.  Sponge, lap and needle counts were correct x3.  The patient was taken to the recovery room in stable condition.