C-Section + Total Abdominal Hysterectomy

Report

The patient was brought to the operating room after her spinal, IV line,preparation,
and Foley had been performed
Aseptic and antiseptic were performed with betadine and alcohol 70 % on the
operative area.The abdomen was prepped and draped in a sterile fashion
Pfannenstiel incision was made with the first knife and carried down to the fascia
with a second knife. The fascia was cleared of subcutaneous tissue.
The rectus muscles were separated by sharp dissection. The rectus muscles were
divided in the midline by sharp dissection. The parietoperitoneum was grasped
with hemostats and carefully entered with a scalpel, and the incision extended
with Metzenbaum scissors. The bladder blade was inserted. The visceroperitoneum
was grasped with smooth pickups, entered with Metzenbaum scissors, and
extended laterally. Uterus gravidarum identified according to gestational age.
Identification the fallopian tubes and ovarium. Cervical incision was performed at
low segmen of uterus.
Amniotic fluid identified as meconeal. A living female infant weighed 3600 gr, 50
cm in length, A/S 5 /3, and anus (+) was delivered. The baby was suctioned and
cried immediately, and was handed to the pediatric team in attendance. The
placenta was delivered manually.
.

 The bleeeding was uncontrollable. after massage of the uterus and

uterotonica has given, the uterus was noted to have bad contraction, so the
total abdominal hysterectomy was performed.
The round ligament on the right side was clamped, cut, and suture ligated
with 0 Vicryl suture ligature. This procedure was then repeated on the
opposite side. The infundibulopelvic ligament on the right side was clamped,
cut, and suture ligated with 0 Vicryl suture ligature, and the procedure was
repeated on the opposite side. The uterine artery and blood vessels were
then skeletonized, clamped, cut, and suture ligated with 0 Vicryl suture
ligature bilaterally. The cardinal ligament was then clamped, cut, and suture
ligated with 0 Vicryl suture ligature in 2 separate bites bilaterally.
The cervix was then whirled off of the vagina. A figure-of-eight suture
ligature was placed at each angle of the vagina to incorporate the cardinal
ligament for support. The vaginal cuff was then closed with a 0 Vicryl suture
ligature in a continuous fashion locking every stitch for hemostasis.
The abdominal cavity was cleansed and sutured by layers. Urinary output
was adequate. The patient left to the recovery room in good condition

Post operative therapy

IVFD RL 20 gtt
Inj. Ceftriaxone 1 gr/12 hrs
Inj Gentamicin 80 mg/ 8 hrs
Inj. Ketorolac 30 mg/ 8 hrs
Inj. Ranitidin 50 mg/ 12 hrs
Inj. Transamin 500 mg/8 hrs ( first 24 hrs)
Inj. Methergin 1 amp/ 8 hrs ( first 24 hrs)
plan :
- evaluation blood routine test post STAH
- Monitor vital sign, contraction,bleeding