A.Y., a gravida 2, para 1 at 39 weeks gestation, had been in active labor for several hours, fully effaced and dilated, yet unable to progress. She had had an uneventful pregnancy with good health, moderate weight gain, good fetal heart sounds, and no signs or symptoms of pregnancy-induced hypertension. X-ray pelvimetry revealed CPD with the fetus in right occiput posterior position. Changes in fetal heart rate indicated fetal distress. A.Y. was transported to the OR for emergency C-section under spinal anesthesia.
After being placed in the supine position, A.Y. had a urethral catheter inserted and her abdomen was prepped with antimicrobial solution. After draping, a transverse suprapubic incision was made. Dissection was continued through the muscle layers to the uterus, with care not to nick the bladder. The uterus was incised through the lower segment, 2 cm from the bladder. The fetal head was gently elevated through the incision while the assistant put gentle pressure on the fundus. The baby's mouth and nose were suctioned with a bulb syringe, and the umbilical cord was clamped and cut. The baby was handed off to an attending pediatrician and OB nurse and placed in a radiant neonate warmer bed. The Apgar score was 9/9. The placenta was gently delivered from the uterus, and the scrub nurse checked for three vessels and filled two sterile test tubes with cord blood for lab analysis. A.Y. was given an injection of Pitocin to stimulate uterine contraction. The uterus and abdomen were closed, and A.Y. was transported to the PACU (postanesthesia care unit).
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