Dr. Martinez will be providing the postpartum

Dr. Martinez will be providing the postpartum care for this patient. LOCATION: Inpatient, Hospital PATIENT: Glenda Freemont ATTENDING PHYSICIAN: Andy Martinez, MD SURGEON: Andy Martinez, MD PREOPERATIVE DIAGNOSIS: Intrauterine pregnancy at 31 weeks and 2 days. POSTOPERATIVE DIAGNOSIS: Same as Preoperative. PROCEDURE PERFORMED: Primary low transverse cervical cesarean section. ANESTHESIA: General endotracheal. SURGICAL INDICATIONS: The patient is a 26-year-old gravida 3, para 2, at 31 weeks and 2 days by menstrual dates, who presents with uterine bleeding. She had an apparent abruption on ultrasound, and the vagina was filled with blood clot. For these reasons she was taken to surgery for an emergency cesarean section. OPERATIVE FINDINGS: The infant is a female, born at 1006 hours, weighing 5 lb 1 ounce, with Apgar scores of 8 at 1 minute and 9 at 5 minutes. There was a lot of blood in the uterine cavity and some adherent clot to the placenta, estimated to be less than a 10% abruption. The tubes and ovaries were normal. PROCEDURE: The abdomen was prepped and draped. A Foley catheter was in. The patient was then given a general endotracheal anesthetic and the abdomen was opened through a Pfannenstiel incision. The bladder flap was opened transversely with scissors, and the bladder was dissected downward bluntly with a hand. A small incision was made in the myometrium of the lower uterine segment, and then entry into the uterus was accomplished bluntly with a Kelly clamp. Low transverse incision was made with bandage scissors. The infant was delivered without undue difficulty. The infant’s mouth and nose were suctioned with a bulb syringe, the cord was clamped and cut, and the infant was handed to the intensive neonatal team. A segment of cord was taken for cord blood gases, and the placenta was then delivered manually. Inspection of the uterine incision revealed there was a brisk bleeder near the left corner of the incision, and this was oversewn initially, with the first layer a running locked 0 Vicryl and the second layer a running horizontal Lembert 0 Vicryl. The pelvis was irrigated with saline. The uterine incision was inspected and there was small amount of oozing from the incision, which was controlled with a singular figure-of-eight 0 Vicryl. When hemostasis was adequate and lap sponges were correct, attention was directed toward closure. The peritoneum was loosely approximated in the midline with a couple of mattress sutures of 2-0 Vicryl. A medium Hemovac drain was placed subfascially to exit below the right side of the incision. The fascia was closed with running 0 Vicryl using two strands, one from either side to the middle and tied independently. The skin was closed with staples and the drain sutured to the skin with silk. Estimated blood loss was 1200-1500 cc. Specimen to pathology was placenta. Final sponge and needle counts were correct. Pathology Report Later Indicated: Normal placental tissue. CPT Code(s): ICD-10-CM Code(s):

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