Intraoperative Findings:

Name: Parcon, RusselAge: 32 years oldPre-op Diagnosis: G2P1 (1001) intrauterine pregnancy 39 2/7 weeks age of gestation, cephalic not in labor, S/P primary low transverse caesarean section for midplane contraction (2009), S/P excision of breast mass left (2001)Post-op Diagnosis: G2P2 (2002) pregnancy uterine delivered to a term, cephalic live baby boy, appropriate for age of gestation with body weight of 3575 g, APGAR score of 8/9, pediatric aging of 38-39 weeks via repeat low transverse caesarean section for scarred uterusIntraoperative Findings:Gravid uterus appropriate for age of gestationLower uterine segment well-formedAmniotic fluid- adequate and thickly meconium stainedDelivery of a live baby boy in cephalic presentation with BW= 3575, BL= 56 cm; HC= 35 cm; CC= 34 cm; AG= 32 cm, AS= 8&9; PA= 38-39 wksPlacenta implanted at the posterofundal areaBilateral ovaries and fallopian tubes are grossly normal

1. Induction of spinal anesthesia.2. Insertion of foley catheter attached to urobag.3. Asepsis/ antisepsis4. Drapings placed exposing the operative site.5. Vertical, midline, infraumbilical incision was made on the skin removing the old scar and deepened through the subcutaneous fat, fascia, rectus muscle split and parietal peritoneum dissected using metzembaum scissors.6. Self retaining and bladder retractors applied.7. Transverse curvilinear incision done at the anterior lower uterine segment after a bladder flap was made.8. Amniotomy done thickly meconium stained, adequate amniotic fluid9. Delivery of a live baby boy in cephalic presentation 10. Umbilical cord clamped and cut.11. Placenta extracted manually and completely.12. Uterine cavity cleared with blood and blood clots.13. Closure of uterus layer by layer:1st layer- Continuous interlocking (chromic 1)2nd layer- Simple continuous (chromic 1)3rd layer- simple continuous (chromic 2-0)14. Inspection of ovaries and fallopian tubes- grossly normal15. Bleeders checked and gutters cleaned.16. Closure of abdominal wall layer by layer:Peritoneum- simple continuous (chromic 2-0)Fascia- continuous interlocking (vicryl 1-0)Subcutaneous- simple interrupted ( plain 2-0)Skin- subcuticular stitch (monocryl 4-0)17. Betadine paint and top dressing applied18. Internal examination and evacuation of blood clots.19. End of procedure.Dr. Bitera/Dr.Espanta/Dr.Lapor/JI Rapacon