DESCRIPTION OF PROCEDURE: The patient had been brought in by paramedics,
currently undergoing CPR as the patient had been found down at home. The
patient did not have a pulse and was in asystole. I had arrived at a time
after being informed of the patient about to arrive in that condition. The
patient was moved from the gurney to the ER table and a surgical tray had
been opened. I had informed the ER physician that a perimortem cesarean
section would be preferable, to be performed at that moment. There was a
low midline skin scar in the abdomen and after being gowned and gloved, I
had a time, an incision with the scalpel was made rapidly through the low
midline skin incision and fascia and into the peritoneal cavity with one
stroke. The abdomen was held open and a vertical incision was made in the
uterus, which otherwise appeared pale. The infant was immediately
delivered via vertex extraction. The cord was doubly clamped and incised.
The infant handed to the neonatologist. The placenta was delivered
manually. The uterus was inspected and otherwise appeared normal. There
appeared to be some clot attached to the omentum off to the left side and
some moderate bleeding from the upper abdomen. At that point, the uterine
incision was closed with 3-0 Vicryl suture that was available. The uterus
was not bleeding and was thin walled and adequately approximated with the
3-0 Vicryl suture. I then inspected the upper abdomen where there appeared
to be moderate amount of blood and some additional clots and blood appeared
to be coming from the left upper quadrant. I could not find any active
bleeding. The patient still was undergoing a vigorous chest compressions
and still had not had a pulse. There was the possibility of some
irregularity along the spleen and therefore, I chose to pack the left upper
quadrant with 3 laparotomy pads. I was not able to close the abdomen
because of the vigorous chest compression that would not allow sutures to
hold the incision together. I also felt that further abdominal exploration
may be needed if the patient could be stabilized. Therefore, the incision
was left open and covered with a sterile laparotomy pad. At that point,
the procedure was terminated.

Thank you in advance,