OPERATING ROOM

RECORD OF OPERATION
DATE: __________________
FAMILY NAME FIRST NAME MIDDLE NAME ROOM NO. BED NO. PATIENT ID NO.

ATTENDING PHYSICIAN AGE: GENDER: CS:

ADDRESS: BIRTHDATE:

SURGEON: FIRST ASSISTANT: SECOND ASSISTANT:

ANESTHESIST: ANESTHETIC: TIME BEGAN:

TIME ENDED:
SURGICAL NURSE: INSTRUMENT NURSE: TIME OPERATION TIME OPERATION
BEGAN: ENDED:

DRAINS (KIND AND NUMBER): SPONGE COUNT VERIFIED:

PREOPERATIVE DIAGNOSIS: OPERATIVE DIAGNOSIS:

MATERIAL FORWARDED TO LABORATORY FOR EXAMINATION:

OPERATION PERFORMED:
 MAJOR MEDIUM

MINOR DIAGNOSTIC
PROCEDURE
DESCRIPTION OF OPERATION
TECHNIQUE (TO INCLUDE INCISION, DRAINAGE, SUTURES)
 Patient placed in supine position under Spinal anesthesia
 Indwelling folley catheter inserted
 Internal examination done revealing the following: vervix 4 cm dilated, 50% effaced, ruptured bag of water,
compound presentation with two fingers on top of the head, Station-3
 Asepsis and antisepsis technique done
 Sterile drapes were placed
 Midline infraumbilical incision done on the skin and carried down to the peritoneum
 Gravid uterus exposed, vesicouterine fold lifted, incised and deflected
 Bilateral round ligaments identified
 Transverse curvilinear incision done on the lower uterine segment
 Baby delivered by gently scooping the head followed by gentle traction; umbilical cord doubly clamped and cut
after complete cessation of pulsations; placenta delivered by genito traction
 Uterine cavity cleansed with sterile gauze
 Uterus closed in anatomic layers:
 1st layer – continuous interlocking suture using Chromic 0
 2nd layer – simple continuous suture using Chromic 0
 Peritoneum – simple continuous suture using Chromic 2-0
 Bleeding checked
 Hemostasis done
 Pelvic organs inspected
 Abdomen closed in anatomic layers after complete os, needles and instrument count:
 Peritoneum – simple continuous suture using Chromic 2-0
 Fascia – continuous interlocking suture using Vicryl-0
 Subcutaneous – simple continuous suture using plain 2-0
 Skin – closed subcuticularly using Chromic 2-0
 Sterile dressing was placed
 Blood clots per vagina evacuated
 Patient tolerated the procedure well

_________________________
SIGNATURE OF SURGEON