No.

MR

10

28

00

00

OBSTETRIC AND GINECOLOGY DEPARTEMENT

CHRISTIAN UNIVERSITY OF INDONESIA HOSPITAL
Jl. Mayjen Sutoyo no. 2, Cawang, Jakarta Timur, 13630
Tel. 021 8092317 ext. 108 / 205

OPERATION REPORT
Nama : Mrs. Endah
Sex : Female
Age : 36 Years
Operator
Prof. Dr. H.I.O Marsis, SpOG
Anesthetic
dr. Ezra, Sp An
Asisten 1 dr. Benhur
Instrumentator Zr. Ria
Asisten 2 Melisa Silvia Sembiring
Observer
Putu Tara Judica Wahyudyasa
Pre-operation Diagnose :G2P1 A0+ insufficiency plasenta +
history of small weight baby + chronic hypertension
Post-operation Diagnose : P2A0, post SCTP e.c CPD,
insufficiency plasenta + history of small weight baby +
chronic hypertension
Tehnique of operation :
1. Sectio caesarea trans peritoneal profunda
2. 3. -

Date of operation : December 3rd

2012
Duration of operation : 1 hours 20
minute
Type of operation
Emergency
Minor
Poliklinik
Medium
Elektif
Mayor

Operation Prosedures :
I.

Patient slept in supine position with spinal anastesia

II.

Aplied inside the dower catheter

III.

Aseptic and antiseptic on abdomen adjacent regio until 1/3 proksimal upper leg and the
operation field was limited with steril doek

IV.

Pfanenstiel incision was made around fibritio tissue, 15 cm length and the skin fold in
down abdomen regio was thrown, the incision was made deeper sliece by sliece from
cutis, subcutis, fascia with sharp technique. Then musculus rectus abdominis it
separated to lateral section with dull technique, bleeding was taken care off.

V.

Peritoneum parietal was opened upside and downside so we can see uterine gravidarum,
and the 2 curavor were put inside the right and left abdomen cavity for sperating the
uterine and the other organ

VI.

Transversal incision was made on lower segment of uterus, extend to right and left until
we can saw liquor amnii membran and then the operator brook the liquor amnii
membran, liquor amnii was clear and we could saw babys head

VII.

Babys head was pulled out with using forceps and with mild pressure on the fundus
uterine by assistant. Then delivered step by step, front shoulder, back shoulder,
backward trochanter anterior, trochanter posterior, breech, extremitas inferior.

VIII.

The baby was crying, umbilical cord was clomped on 2 place 5 cm and 7 cm from the
umbilical cord, then it was cut between 2 clamp and the baby was delivered to
perinatologi

IX.

The new born baby was delivered at 16.30 WIB, with female gender, body weight birth
2500 gr, leght birth 45 cm, Apgar Score 8/9, anal (+) and didt saw major congenital
disorder

X.

Plasenta was completely born in manual, cavum uterine was cleaned from the residual
plasenta tissue with sharp curretase post partum until surely clean. Bleeding was
controlled. After that the uterine tissue was sewed and over hecting with chromic cat
gut no. 2

XI.

Suture was done on lower segmen of uterine at two pole with chromic cat gut no. 2
and then the miometrium tissue was suture by continue
-

First slice of miometrium tissue with Chromic cat gut no. 2 by interlocking

Second slice of miometrium tissue and serosum was suture by continue with
Chromic cat gut no. 2

XII.

The abdomen cavity was cleaned and 2 curavor was pulled out from the abdomen
cavity

XIII.

Before the abdomen cavity was sewed, it was giving cortisone asetat 2,5 mg into
peritoneal cavity

XIV. After sure its no bleeding, abdomen cavity was objed slice by slice
a. Peritoneum parietal was sutured with chromic cat gut no. 2.0 by continue
b. M. Rectus abdominis was sutured with chromic cat gut no. 1.0 by continue
c. Fascia was sutured with vicryl no. 1 by simple suture
d. Subcutis was sutured with chromic cat gut no. 2.0 by simple suture
e. Cutis was sutured with Plain cat gut no. 3.0 by subkuticuler
XV.

Bleeding approximately 500cc

XVI. Cavum vagina was cleaned pervaginam with cassa and bethadine
XVII. The operation wound was cleaned by cleaning stole cell from the vagina, the operation
wound was cleaned with Nacl 0,9 % and then it was given antibiotic zalf and then was
closed by sufratulle, sterill cassa and tegaderm

XVIII. The operation finished

The condition of patient post operation:

General condition

: Look mild sick

Blood pressure

: 180/100 mmHg

Pulse rate

: 88 x/minute

Respiration

: 20 x/minute

Temperature

: 37 oC

Tissue to Pathology of Anatomy :

Yes
No

Operator,

(Prof. dr. H.I.O Marsis, SpOG)