D&C - DILATATION AND CURETTAGE

PREOPERATIVE DIAGNOSIS: Missed first trimester abortion.

POSTOPERATIVE DIAGNOSIS: Missed first trimester abortion.

OPERATION PERFORMED: Dilatation and curettage.

SURGEON: John Smith, M.D.

ANESTHESIA GIVEN: General endotracheal anesthesia.

INDICATIONS FOR PROCEDURE: This is a 29-year-old white female, gravida 4, para 1, abortus 2, who was at 12 week's gestation. One week ago, she had an ultrasound done which

showed a viable pole, consistent with 7 weeks 5 days. Today, she has had spotting for 3-4 days. Cervix is closed. Uterus is boggy. Intravaginal ultrasound showed an 8-week embryo which was nonviable. The patient observed this and it was quite obvious that it was a nonviable embryo. She is taken to the operating room now for a dilatation and curettage procedure.

DESCRIPTION OF OPERATIVE PROCEDURE: With the patient in the supine position under a satisfactory level of general anesthesia with endotracheal intubation, the patient's legs were placed in the lithotomy position. She was prepped and draped in the usual sterile fashion. The urinary bladder was catheterized.

Examination revealed a retroverted boggy 12-week sized uterus. The cervix was grasped with a single-toothed tenaculum. The cervix would easily pass a #20 Hanks dilator. A 10-mm suction curet was placed and a large amount of tissue and blood were removed. The uterus then was sounded again to 11 cm. Total blood loss was about 75 cc.

The patient was awakened and taken to the postoperative recovery room in good condition.

CESAREAN SECTION

PREOPERATIVE DIAGNOSIS: Nonreassuring fetal heart rate pattern.

POSTOPERATIVE DIAGNOSIS: Nonreassuring fetal heart rate pattern.

OPERATION PERFORMED: Primary emergent cesarean section with a low transverse uterine incision.

SURGEON: John Smith, M.D.

ANESTHESIA GIVEN: General endotracheal anesthesia.

INDICATIONS FOR PROCEDURE: This is a 19-year-old white female, gravida 1, estimated date of confinement 07/02/2004, who was admitted for induction secondary to post-datism. Her cervix was thick and closed. Cervidil was placed. Around 2:00 a.m., she began having decelerations and Cervidil was removed. Oxygen was started and the fetal heart rate pattern improved. However, we watched this very closely and she progressed to about 9 cm, but began having significant decelerations again. There was loss of variability and the decelerations appeared to be late decelerations. She was given Terbutaline intravenously as tocolysis and operating room crew was called for a STAT cesarean section.

DESCRIPTION OF OPERATIVE PROCEDURE: With the patient in the supine position, the abdomen was prepped with isopropyl alcohol. She was draped in the usual fashion with an Ioban drape. Crash induction of general anesthesia with endotracheal intubation was performed.

A Pfannenstiel skin incision was made and extended through the subcutaneous tissue to the fascia. The fascia was incised transversely. The underlying muscles were sharply and bluntly divided. Muscles were divided in the midline. The peritoneum was entered sharply. The anterior uterine peritoneum was incised transversely. A bladder flap was developed and a low transverse uterine incision was made with the knife and extended bluntly. The infant's head was delivered. There was a nuchal cord x 1 which was reduced. The infant's nasopharynx and choanae were suctioned with delivery of the body. The cord was doubly clamped and divided with delivery of the body. The infant was handed off to the waiting pediatrician. Apgar scores were 8 at one minute and 9 at five minutes. Cord blood was obtained. The placenta was manually removed. The uterus was exteriorized. The uterine cavity was explored and found to be free of retained secundum. The uterine incision was closed with a single layer of running, locking 2-0 Vicryl suture. The abdomen was evacuated of clots, sponges, and debris.

The muscles were reapproximated in the midline with interrupted 2-0 Vicryl sutures. The fascia was closed with running looped 0-PDS and 3-0 Vicryl subdermal sutures were placed. Skin was closed with staples. Sterile dressing was placed. The patient was awakened and taken to the postoperative recovery room in good condition, having tolerated the procedure well. Estimated blood loss was 600 cc. Sharp count and sponge count were correct.

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