DESCRIPTION OF OPERATION: After informed consent was obtained, the patient was taken to the operating suite and an adequate anesthetic level was confirmed. A Foley catheter had been previously placed or was placed in the operating suite. The patient was placed in the supine position, left lateral tilt, and prepped and draped in the usual sterile fashion for cesarean section. A Pfannenstiel skin incision was made with a knife and carried down sharply through the subcutaneous tissues. The fascia was incised in the midline and the fascial incision was extended laterally and elliptically using curved Mayo scissors. Sharp and blunt dissection was then used to separate the fascia from the underlying rectus muscles. The rectus muscles were divided in the midline and the peritoneum was entered using sharp dissection. The peritoneal incision was extended superiorly and inferiorly down to the level of the dome of the bladder. Next, the operative hand was used to determine the position of the uterus, which was noted to be midline. The vesicouterine peritoneum was then incised and sharp and blunt dissection was then used to separate the bladder from the lower uterine segment. The bladder blade was then placed. Next, a transverse incision was made in the lower uterine segment and carried down sharply until the amniotic membranes were ruptured and this confirmed clear fluid. The incision was then extended using the bandage scissors in a transverse manner. The fetal head was grasped, flexed and delivered through the incision. The infant's nose and mouth were suctioned. The rest of the infant was delivered. The cord was doubly clamped and cut awaiting nursery team. At this time, a specimen of cord blood was obtained and Pitocin was added to the IV fluid. The placenta was then manually extracted from its implantation site. The uterus was exteriorized and draped in a moist lap. The endometrial cavity was curetted with a dry lap to free it of any remaining products of conception. The incision was inspected and noted to be free of extensions. The incision was closed in a single layer of running locking #1 chromic suture. The incision was confirmed to be hemostatic. The uterus was returned to the intra-abdominal site. The paracolic gutters were cleansed with a moist lap. The peritoneum was then reapproximated using running 3-0 Vicryl suture. The subfascial space was confirmed to be hemostatic. The fascia was reapproximated using 2-0 PDS suture, beginning at the lateral margins of the incision and meeting in the midline. The subcutaneous tissues were made hemostatic with electrocautery and the skin was then reapproximated with skin staples. The patient tolerated the procedure well. All counts were correct x3, and the patient was transferred to the recovery room in good condition.
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