OB-GYN transcription sample

TITLE OF OPERATION:
Repeat lower-segment transverse cesarean section.
REOPERATIVE DIAGNOSES:
1. INTRAUTERINE PREGNANCY AT 39-5/7 WEEKS GESTATION.
2. ARREST OF SECOND STAGE OF LABOR AND DESCENT.
3. RULE OUT ABRUPTION VERSUS UTERINE DEHISCENCE.

POSTOPERATIVE DIAGNOSES:
1. ARREST OF DESCENT.
2. LEFT UTERINE ARTERY LACERATION.

TITLE OF SURGERY: REPEAT LOWER-SEGMENT TRANSVERSE CESAREAN SECTION.

ANESTHESIA: EPIDURAL.

ESTIMATED BLOOD LOSS: 1000 CC.

FINDINGS: A living female infant, vertex, right occipitotransverse position, weight 6 lbs., 2722 gm, Apgar scores 9 and 9.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room after her epidural, preparation, and Foley had been performed. The abdomen was prepped and draped and tested for analgesia. When found to be adequate, a repeat low-abdominal Pfannenstiel incision was made with the first knife and carried down to the fascia with a second knife. The fascia was cleared of subcutaneous tissue. Bleeding points were clamped with hemostats and Bovie coagulated. The fascia was incised in the midline and extended laterally with curved Mayo scissors. Kocher clamps were placed on the fascial edge, first anteriorly and then superiorly.

The rectus muscles were separated by sharp dissection. A 5-yard roll was placed over the superior Kocher clamps and placed over the head of the table for retraction. The rectus muscles were divided in the midline by sharp dissection. The parietoperitoneum was grasped with hemostats and carefully entered with a scalpel, and the incision extended with Metzenbaum scissors. The bladder blade was inserted. The visceroperitoneum was grasped with smooth pickups, entered with Metzenbaum scissors, and extended laterally. The bladder flap was created by gentle blunt dissection and placed behind the bladder blade. The lower uterine segment was noted to be quite thin; it was carefully incised with a scalpel and extended laterally with bandage scissors.

A living female infant was delivered from the vertex right occipitotransverse position. The head was noted to be wedged into the pelvis but was easily elevated with a hand. The baby was suctioned and cried immediately, and was handed to the pediatric team in attendance. There was some blood in the intrauterine cavity but no evidence of a dehiscence or an abruption.

The placenta was delivered manually. The uterus was explored with a wet lap sponge and found to be clear of membranes. There was marked bleeding coming from the laceration of the left uterine artery. The angles of the incision were sutured first with #1 chromic catgut suture; however, the laceration was noted to be lateral to the initial placement and a repeat angled suture was placed. The first layer of uterine closure was with running-locking #1 chromic catgut suture. The second layer was with imbricating #1 chromic catgut suture. An interrupted #1 chromic was also placed at the left angle to control hemostasis. The second layer of uterine closure was imbricating #1 chromic catgut suture. Hemostasis was carefully checked and found to be satisfactory. The bladder flap was closed with a running 2-0 chromic catgut suture. The fallopian tubes and ovaries were inspected and found to be normal bilaterally.

After correct lap and instrument counts, the peritoneum was closed with a running 2-0 chromic catgut suture. The rectus muscles were approximated in the low midline with an interrupted #1 chromic catgut suture. The Kocher clamps and 5-yard roll were removed. This fascia was closed with two running 0-Vicryl from lateral to midline. The subcutaneous tissue was approximated with interrupted 2-0 plain catgut. The scar on the lower incision of the skin was removed with Allis clamps, elevating it and excising it with a scalpel. Bleeding points were Bovie coagulated.

The subcutaneous tissue was approximated with 2-0 plain catgut. The skin was closed with staples. Urinary output was adequate and blood-tinged. The patient left to the recovery room in good condition.