Induction of anesthesia

Asepsis and antisepsis

Sterile drapes applied
A vertical incision was done from the infraumbilical area to just above the symphysis
Incision deepened to subcutaneous tissue and fascia, ligating bleeders along the way
Peritoneum lifted and cut longitudinally
Self- retaining and bladder retractors applied
The uterus was globularly enlarged, and patches of hematoma were noted more on
the lower uterine segment
The lower uterine segment was well formed
The vesicouterine fold was lifted and cut
The uterus was cut curvilinear
The amniotic fluid ruptured and was moderate in amount
A dead baby boy in cephalic occiput posterior position was delivered with no
difficulty
The umbilical cord was doubly clamped and cut in between
The placenta was implanted anteriorly, high lying & noted to be detached from the
serosa of about 75%

 About 1 liters of endometrial blood clot was evacuated

The uterus with couvelaire of 75 % was cleansed with clean OS removing
membranes and blood clot
The uterus was closed in layers:
o 1st layer: continuous interlocking using Monocryl 0
o 2nd layer: continuous interlocking using Monocryl 0
o Peritoneum: continuous running suture using Chromic 2-0 T10 atraumatic
The abdominal cavity was cleansed of spilled blood and blood clots
The ovaries and fallopian tubes were grossly normal
The abdomen was closed in layers; ligating bleeders along the way
o Peritoneum: continuous running using Chromic 2- 0 T10 Atraumatic
o Fascia: continuous interlocking using Vicryl 1
o Subcutaneous tissues: simple interrupted using Plain 2- 0
o Skin coaptated subcuticularly using Vicryl 4- 0
Sterile dressing applied
Estimated blood loss: 1500cc
Patient tolerated the procedure well

Augustia I. Arenas, M.D., FPOGS/Almarie D. Pandao-Mangondato, M.D.

Surgeons
Rosalyn Cristobal Martho
323111
May 1, 2011