Cesarean Conservative Report d/t PASD (PAS 1) + Prev.

C-Section 1 time + Transverse Lie + Post Pomeroy

Sterilization
On Wednesday, January 10th 2023 at 14.00 p.m, by Cesarean Hysterectomy born a Male baby, BW: 3.500 gr, BL: 50
cm, Apgar Score 9/10, Anal (+), NBS 38 appropriate (37) wga

• The patient was laid on the operating table, with IV line and urinary catheter installed.
• Under Spinal anesthesia, antiseptic and aseptic procedures were performed using povidone iodine on the abdomen,
and then draped leaving the surgical field exposed. Midline incision was made, through to the underlying layer of
fascia. The fascia was incised and extended using scissor. The underlying muscles were separated.
• Peritoneum was identified. Seen adhesion between peritoneum and uterus. Adhesiolysis was performed. The
peritoneum was elevated using clamp and entered using Metzenbaum scissor with care for the underlying organ,
and extended superiorly and inferiorly with careful visualization of the bladder.
• Seen uterus gravidarum. After separating the vesicouterine fold, fundal incision was performed until
subendometrium layer.
• Endometrium penetrated and widened bluntly. Amniotic membrane was visible and subsequently ruptured,
amniotic fluid was clear.
• By pulling voth feet born male baby with BW 3500 gr, BL: 50 cm, AS 9/10, anal (+) .
• The umbilical cord was clamped in two places and cut in between, the placental end of the mother's part was
sutured. Placenta was left inside uterus.
• Uterus was conditional sutured by continuous stitches.
• Evaluation of uterus gravidarum, the lower uterine segment was identified. Seen bulging part of the lower uterine
segment
• Identification of right fallopian tubes and ovaries, within normal limit. Identification of left fallopian tubes and
ovaries, within normal limit
• Total Abdominal Hysterectomy was performed
• The left rotundum ligament was clamped using 2 kocher clamps, and was cut in between. Anterior lamina
ligamentum latum was opened till the plica vesicouterina. The same was done on the right side. Posterior lamina
ligamentum latum on the left side, below the fallopian tube. The IP ligament was gently pushed using two fingers
anteriorly till a hole is formed. Through that hole the left IP ligament was clamped using 2 ochsner clamp, cut in
between and the lateral punctum was tied using chromic no. 2.0 thread, and the medial punctum was tied using a
zyde thread.
• On the right lamina posterior ligamentum latum,below the fallopian tube and the ligamentum ovarii proprium.
Posterior lamina ligamentum latum on the right side,below the fallopian tube. The IP ligament was gently pushed
using two fingers anteriorly till a hole is formed. Through that hole the right IP ligament was clamped using 2
ochsner clamp ,cut in between. The lateral punctum was tied using the chromic no.2.0 thread, while the medial
punctum was tied using a zyde thread.
• Identification of the left uterine artery/vein on the lateral side was done by evaluating the uterus on the opoosite
side. The artery/vein was clamped using 2 oschner clamps held at straight position,cut in between, seen
adhesiveness, part of isthmus was incisied and sutured with vycril no. 1. Latum and saccrouterine ligament was
sutured.
• Identification of the left uterine artery/vein on the lateral side was done by evaluating the uterus on the
opoosite side. The artery/vein was clamped using 2 oschner clamps held at straight position,cut in
between, seen adhesiveness, part of isthmus was incisied and sutured with vycril no. 1. Latum and
saccrouterine ligament was sutured.
• The vesicaurinaria was separated from the lower uterine part layer by layer, seen the placenta was
attached to the bladder wall, bladder was filled with 200 cc of Normal Saline, rupture of bladder was not
found.
• Abdominal drain was installed.
• Hack blass and the sterile operating cloth was removed. The abdominal area was rinsed using warm
physiologic NaCl + Aqua till clean.
• The peritoneum was sewn using plain catgut no.3.0, the muscular area was sewn using simple suture
method with plain cat gut no.00. Fascia was sewn using vicryl no.1, sub cutis area sewn using simple
method with chromic no.2.0, cutis sewn using subcuticuler method with vicryl no. 2.0. The post
operation scar was cleaned using betadine and covered using sterile gauze.
• Operation complete, patient post operation condition was stable. Blood transfusion during operation was
2 packs of PRC .
Surgical Finding
Diagnosis :
Post Cesarean Conservative d/t PASD (PAS 1) + Prev. C-Section 1 time + Transverse Lie + Post Pomeroy
Sterilization+ PD-0

Therapy :
- IVFD RL 500 ml 20 dpm
-Inj. Ceftriaxone 1 gr / 12 hours
-Inj. Ketorolac 30mg/8 hours
- Inj. Ranitidine 50mg/12 hours
- Inj. Tranexamic acid 500mg/8 hours

Plan :
Monitoring vital sign, vaginal bleeding, and urine output
Check CBC 6 hrs post Transfusion

Reported to supervisor on duty dr. Risman F. Kaban, M.Ked(OG), Sp.O.G Approved