AUDIT REPORT T11.1 OPERATIVE REPORT, CESAREAN

question 2

Essay

AUDIT REPORT T11.1 OPERATIVE REPORT, CESAREAN
SECTION
PREOPERATIVE DIAGNOSIS:
1. Spontaneous rupture of the membranes.
2. Failure to progress.
POSTOPERATIVE DIAGNOSIS:
1. Spontaneous rupture of the membranes.
2. Failure to progress.
PROCEDURE PERFORMED: Primary low transverse cesarean section.
ANESTHESIA: Epidural with Duramorph.
ESTIMATED BLOOD LOSS: 700 cc
PATIENT: Lisa Logan
FLUIDS: 3000 cc crystalloid
URINE OUTPUT: 90
COMPLICATIONS: None
FINDINGS: A single viable male infant, Apgar's 7 at 1 minute, 9 at 5 minutes, weight 2656 gm (5 pounds 13.7 ounces).
PROCEDURE PERFORMED: Primary low transverse cesarean section.
ANESTHESIA: Epidural with Duramorph.
INDICATIONS: Lisa is a 22-year-old, G1, who presented to her primary obstetrician with ruptured membranes at 38 weeks and was found to have intermittent late decelerations. She was transported here. Pitocin was used to attempt to cause cervical change; however; despite nine hours of attempting to adjust Pitocin without causing late deceleration, she remained at 3 to 4, 90 and 0. The baby began to experience late decelerations, and patient elected to proceed with cesarean. Risks and benefits of surgery were discussed with the patient.
FINDINGS AT THE TIME OF SURGERY: Included single viable male infant, left occiput transverse position, with cord around the neck 1, normal tubes and ovaries, normal uterine contour.
TECHNIQUE: The patient was taken to the operating room, where epidural anesthesia was dosed. She was prepped and draped in a normal sterile fashion, and anesthesia was found to be adequate. A Pfannenstiel skin incision was made with the scalpel and carried through to the underlying fascia, which was nicked in the midline, and the fascial incision was extended bilaterally with Mayo scissors. The superior aspect of the fascial incision was grasped with Kocher clamps, tented up, and the underlying rectus muscles were dissected off with sharp dissection. The inferior aspect of the fascial incision was likewise grasped with Kocher clamps, tented up, and the underlying rectus and pyramidalis muscles were dissected off with sharp dissection. The rectus muscles were separated in the midline, and the incision was extended superiorly and inferiorly, with good visualization of the bladder. The peritoneum was grasped with hemostat, tented up, and entered sharply. The peritoneal incision was extended superiorly and inferiorly with good visualization of the bladder. The rectus muscles were separated in the midline. The bladder blade was inserted. The vesicouterine peritoneum was grasped with pickup, entered sharply, and the incision was extended bilaterally with Metzenbaum scissors. The bladder flap was created digitally. The bladder blade was reinserted. The uterus was transcribed in a transverse manner with the scalpel and extended with bandage scissors. The fetus in left occiput posterior presentation was delivered into the incision, and the fetus was bulb suctioned on the abdomen after delivery. Cord gases were cut and sent. The fetus was handed to NICU after the cord was clamped and cut. The placenta was extracted manually. The uterus was exteriorized, cleared of clots and debris, and the angles of the uterine incision were grasped with ring forceps, and the incision was closed with 0 Vicryl in a running locked fashion, a second imbricating layer was used to achieve hemostasis. The bladder flap was closed with 2-0 Vicryl in a running fashion. The posterior cul-de-sac was copiously irrigated. The uterus was replaced within the abdominal cavity. The pelvic cavity was then copiously irrigated and cleared of clots and debris. Then, the rectus diathesis was closed with 2-0 Vicryl in a running fashion. The fascia was closed with 0 Vicryl in a running fashion, using two sutures beginning at the angles and meeting in the midline. The subcuticular space was closed with 2-0 Vicryl interrupted sutures. The skin was reapproximated with staples. The patient tolerated the procedure well. Sponge, lap, and needle counts were correct, and she was taken to recovery in stable condition.
T11.1:
SERVICE CODE(S): 59510_________________
ICD-10-CM DX CODE(S): O42.92__________
INCORRECT/MISSING CODE(S): ________________________________________

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Definitions:

Perfect Competition

A market structure characterized by many buyers and sellers, homogeneous products, free entry and exit, and full information.

Monopolistic Competition

A market structure marked by many competing firms offering products or services that are similar, but not perfect substitutes.

Oligopoly

A market structure characterized by a small number of firms controlling a large portion of the market share, leading to limited competition.

Long-run Equilibrium

A state in which all factors of production and costs are variable, and all firms in an industry are making normal profit, resulting in market stability over time.