No. MR OBSTETRIC AND GINECOLOGY DEPARTEMENT BUDHI JAYA MOTHER AND CHILD HOSPITAL JL. Dr. Sahardjo No.

120 Jakarta Selatan 12960 Telp. (021) 8292672, 8311722, 8312378 Fax. 8301901 OPERATION REPORT Nama : Mrs. Carolyne Dewi Anggraini Sex : Female Operator Prof. Dr. H.I.O Marsis, SpOG Anesthetic Assistant 1 Daniel Matius Instrumentator Assistant 2 dr. Benhur Sibuea Observer Pre-operation Diagnose : Cephalopelvic disproportion + Previous sectio caesarea one times + Enough Children + History of secondary infertility at 38th weeks in gestation with Gravid 2, Para 1, Abortus 0 Post-operation Diagnose : Cephalopelvic disproportion + Enough Children + History of secondary infertility Tehnique of operation : 1. Sectio caesarea trans peritoneal profunda 2. Tubectomy 3. Operation Procedures: I. II. III.

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Age : 40 Years dr. Widodo, Sp An Bd. Lathifa Melati Pratiwi

Date of operation : July 11th 2013 Duration of operation : 1 hours 30 minutes Type of operation Emergency Minor Poliklinik Medium Elektif Mayor

Patient slept in supine position with spinal anastesia on operation table Aplied inside the dower catether Aseptic and antiseptic on abdomen adjacent regio until 1/3 proximal upper leg and the operation field was limited with steril doek

IV.

Pfanenstiel incision was made around fibritio tissue and the skin fold in down abdomen regio was thrown, the incision was made deeper slice by slice from cutis, subcutis, fascia with sharp technique. Then musculus rectus abdominis it separated to lateral section with dull technique, bleeding was taken care off.

V.

Peritoneum parietal was opened upside and downside so we can see uterine gravidarum, and 2 curavors were put inside the right and left abdomen cavity for seperating the uterine and the other organ

VI.

Opened plica versico uterine and continued incision to left and right lateral and put aside to lower.

VII.

Transversal incision was made on lower segment of uterus, extend to right and left until we can saw liquor amnii membran and then the operator brook the liquor amnii membran, liquor amnii was clear and we could saw babys head We saw the babys head upper from the pelvic inlet. Then the babys head was pulled out by forcep extraction and with mild pressure on the fundus uterine by assistance. Then the deliver step by step from head, front shoulder, back shoulder, backward trochanter anterior, trochanter posterior, breech and extremitas inferior was delivered with a sort umbilical cord coil attached to the baby.

VIII. IX.

X.

The baby was crying, umbilical cord was clamped on 2 place 5 cm and 7 cm from the umbilical cord, then it was cut between 2 clamp and the baby was delivered to perinatologi

XI.

The new born baby was delivered at 6.33 am, with male gender, body weight birth 4000 gr, length birth 50 cm, Apgar Score 9/10, anal (+) and didnt saw major congenital disorder

XII.

Plasenta was completely born in manual, cavum sewed and over hecting with chromic cat gut no 2.

uterine was cleaned from the

residual plasenta tissue. Bleeding was controlled. After that the uterine tissue was Suture was done on lower segmen of uterine at two pole with Chromic cat gut no. 1 and then the miometrium tissue was suture by continue and overhecting First slice of miometrium tissue with Chromic cat gut no. 2 by continue Second slice of miometrium tissue and serosum was suture by continue with Chromic cat gut no. 2 Reperitonisation by sutured plica vesica uterine with chromic cat gut no. 2.0 by continue. XIV. Operative procedures of tubectomy : XV. The middle of right fallopian tube lifted then its base was tied by siede no 2.0. 0,5 cm under the tying, tied by chromic cat gut no 2.0. Cut the tuba and cautered. The same procedure is done on the left fallopian tube. The abdomen cavity was cleaned and 2 curavors was pulled out from the abdomen cavity XVI. Before the abdomen cavity sewed, it was giving cortisone asetat 25 mg/10ml into peritoneal cavity

XIII.

XVII. After sure its no bleeding, abdomen cavity was objed slice by slice a. Peritoneum parietal was sutured with Plain cat gut no. 2.0 by continue b. M. Rectus abdominis was sutured with Chromic cat gut no. 1.0 c. Fascia was sutured with vicryl no. 1 by simpl suture d. Subcutis was sutured with Plain cat gut no. 2.0 by simple suture e. Cutis was sutured with Chromic cat gut no. 3.0 by subkuticuler XVIII. Bleeding approximately 200 cc XIX. Cavum uterine was cleaned pervaginam XX. The operation wound was cleaned by cleaning stole cell from the vagina, the operation wound was cleaned with Nacl 0,9 % and then it was given antibiotic zalf and then was closed by sufratulle, sterill cassa and tegaderm XXI. The operation finished

The condition of patient post operation: General condition Blood pressure Pulse rate Respiration Temperature : : : : : Look mild sick 140/80 mmHg 88 x/minute 21 x/minute 36,3 oC

Tissue to Pathology of Anatomy : Yes No : Type of tissue ..........................................

Operator,

(Prof. dr. H.I.O Marsis, SpOG)