Repeat cesarean section

PREOPERATIVE DIAGNOSIS:  Previous cesarean section.

POSTOPERATIVE DIAGNOSIS:  Previous cesarean section.

PROCEDURE:  Repeat cesarean section.

ASSISTANT:  Gail Glennon.

ANESTHESIA:  Spinal.

ESTIMATED BLOOD LOSS:  70 mL

COMPLICATIONS:  None.

FINDINGS:  Beautiful baby girl, Apgars 9 and 9, weight is 7 pounds 5 ounces.  Normal uterus, tubes and ovaries.  Three-vessel cord, intact placenta.

INDICATIONS:  This is a 34-year-old gravida 3, para 1, at term with history of previous cesarean section, otherwise uncomplicated prenatal course.  Risks, benefits, and alternatives discussed with the patient at length including risks of morbidity and mortality of fetus, including risks of morbidity and mortality of mother, including risks of hemorrhage, infection, and injury to bowel, bladder, and uterus.  Risks were accepted.  The patient was taken to the operating room.  Spinal anesthesia was given without difficulty.  She was then prepped and draped in normal sterile fashion, dorsal supine position with leftward tilt.  Pfannenstiel incision was made with scalpel carried through to the underlying layer of fascia with Bovie.  Fascia was incised midline extended laterally.  Rectus muscle dissected with Bovie.  Peritoneum identified and entered.  Bladder flap created.  Uterine incision was made with scalpel, extended laterally.  Moderate meconium was noted.  Baby was delivered from vertex presentation to leave suction at abdomen.  Cord clamped and cut.  Baby handed off to the awaiting pediatrician.  Three-vessel cord intact.  Placenta was delivered spontaneously.  Uterus exteriorized and cleared of all debris.  Uterine incision was repaired with 0 Vicryl in a running fashion.  Second layer was used to obtain hemostasis.  The uterus was returned to the abdomen.  Uterine incision was inspected and noted to be hemostatic.  The gutters were cleared of all clots.  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.