Republic of the Philippines

Department of Health
Central Luzon Center for Health Development
DR. PAULINO J. GARCIA MEMORIAL RESEARCH
AND MEDICAL CENTER
Cabanatuan City
ISO QMS Certified

Name: Age:
Address: Case No:

RECORD OF OPERATION
OPERATION PERFORMED:
NORMAL SPONTANEOUS DELIVERY WITH RIGHT MEDIOLATERAL EPISIOTOMY AND REPAIR OF ___ DEGREE
LACERATION
PRE-OPERATIVE DIAGNOSIS:

OPERATIVE DIAGNOSIS:

SURGEON: SURGEON:

CONSULTANT: CONSULTANT:

TISSUE REMOVED: TISSUE REMOVED:

Operative Technique:

Patient placed on semi-recumbent position

Asepsis and antisepsis.
Application of sterile drapes at the perineal area
Insertion of straight catheter to empty the bladder
Right mediolateral episiotomy done after infiltration of local anesthesia
Delivery of___________________________
4 Core steps of essential newborn care performed
1. Immediate and thorough drying
2. Early skin to skin contact
3. Properly timed cord clamping
4. Non separation of the newborn and mother for early initiation of breastfeeding
Delivery of the placenta. Evacuation of Blood clots
Repair of ___ degree laceration done.
Vaginal inspection. Cleaned with providone iodine antiseptic followed by perineal washing.
Patient tolerated the procedure well.

Obstetrics and Gynecology:

 Republic of the Philippines
Department of Health
Central Luzon Center for Health Development
DR. PAULINO J. GARCIA MEMORIAL RESEARCH
AND MEDICAL CENTER
Cabanatuan City
ISO QMS Certified

Estimated Blood Loss:

PJG-MED-OBG-Form014-Rev02 Effective Date: 04/27/2016