[Expert Solution]: Operation: Primary Cesarean section -…

Operation: Primary Cesarean section – classica l Anesthesia: Epidural Procedure: The patient is a 28-year-old female gravida 1 para 0 who presented at 38 weeks’ gestation with complaints of leaking fluid. The patient was approximately 1 cm dilated and 80 percent effaced at that time. She was felt to be having some leaking, although membranes could still be palpated. Therefore, artificial rupture of membranes was performed. The patient progressed very slowly in labor and required Pitocin augmentation. Over the next 24 hours, she progressed to finally complete dilation and began pushing for 3 hours. She started at approximately 0 to +1 station and progressed to +2 or 3 station. Fetal head was seen with separation of the labia; however, after 3 hours and maternal exhaustion, she made no further progression of the fetal head over the last hours of pushing. The patient was counseled regarding the need for assistance, and forceps assistance versus Cesarean section was offered. The patient opted for a Cesarean section. The patient was taken to the operating room and placed under epidural anesthesia. She was prepped and draped in the normal sterile fashion in dorsal supine position with leftward tilt. Pfannenstiel skin incision was made two fingerbreadths above the symphysis pubis in the midline and carried through to the underlying fascia. The fascia was incised in the midline and extended laterally with Mayo scissors. The rectus muscles were dissected off the fascia using both blunt and sharp dissection. Rectus muscles were then separated in the midline. The peritoneum was entered bluntly and extended superiorly and inferiorly. The bladder blade was inserted. The vesicouterine peritoneum was grasped with pickups and entered with Metzenbaum scissors. This was extended laterally, and the bladder flap was created digitally. The bladder blade was reinserted. The lower uterine segment was incised in a transverse fashion with a scalpel and extended laterally with blunt dissection. The infant’s head was very low in the pelvis. Attempt to deliver the fetal head was difficult, and we were unable to reduce the fetal head from the vaginal canal. Nursing staff did apply pressure to the fetal head from the vaginal canal, but still was unable to be dislodged. An attempt was made to retract on the shoulders of the infant in order to dislodge the fetal head from the vaginal canal, but again this was unsuccessful. For this reason, the uterine incision was extended vertically in a classical fashion, and the feet were grasped and pulled to the uterine incision. The feet were then delivered, and the infant was delivered in a breech fashion. Nose and mouth were suctioned and cord was clamped and cut. The infant was then handed off to the waiting pediatrician. The placenta was removed. The uterus was cleared of clots and debris. The uterus was exteriorized for better visualization; 0 Vicryl sutures were used to close the vertical incision in the uterus icd 10 pcs code