Age: 30.0
Sex: F
Vaccine: COVID19
Symptoms: Vacuum extractor delivery, Vulvovaginal injury, Wound closure
Clinical narrative: Admission Date: 10/15/2022 Discharge Date: 10/18/2022 PROCEDURES PERFORMED:  Vaginal delivery Tubal ligation:  No   HOSPITAL COURSE: Patient underwent an uncomplicated vaginal delivery and was discharged home in stable condition.  DELIVERY TYPE: Vaginal, Vacuum (Extractor)    ESTIMATED DUE DATE: Estimated Date of Delivery: 11/4/22 GESTATIONAL AGE AT DELIVERY: 37w2d  G1P0000  FINDINGS: NEWBORN STATUS: Living  NEWBORN SEX:  girl     Delivery Date/Time:  10/XX/22  9:53 AM           WEIGHT:   APGAR:  1 minutes 5 minutes 10 minutes  8  9        RESCUSITATION: Tactile stimulation  PLACENTA REMOVAL: Spontaneous  CORD VESSELS: 3 Vessels  CORD COMPLICATIONS: Nuchal  ANALGESIA METHOD: Epidural   DELIVERY COURSE: Patiet is a 31 y.o. G1P0000 female who presented to L&D at 37 weeks gestation for induction of labor due to fetal growth restriction. Pregnancy was complicated by maternal POTS, asthma, thrombocytopenia. Labor course included vaginal cytotec. Labor course complicated by category II fetal heart tones after epidural which improved somewhat with intrauterine resuscitation and IV phenylephrine. She progressed to complete at 0900. She pushed well with contractions. Category II fetal heart tones noted with intermittent deep late and prolonged decelerations. With fetus at 3+ station, fetal heart rate dropped to the 70s. Patient was consented to operative vaginal delivery with vacuum. Kiwi omnicup was applied to flexion point on fetal head, ensuring that maternal tissue was excluded. Traction was applied along with maternal effort over one contraction to bring fetal head to a crown. There were no pop offs. The vacuum was removed and patient continued to push. She went on to deliver the fetal head in a controlled fashion.  Head restituted to face maternal left. No  nuchal palpated. Anterior shoulder delivered with gentle downward traction of the head, followed by the posterior shoulder. Rest of the body followed with ease. Time of delivery was 0953. NICU was present at the delivery due to operative delivery and fetal growth restriction.  A female infant was placed on the maternal abdomen and dried by RN.  Delayed cord clamping was performed for 60 seconds and then the cord was clamped x2 and cut by the patient. The infant was then placed skin to skin on maternal chest.  APGARS 8 and 9 . Mixed cord blood was obtained. Arterial and venous blood gases were obtained. Placenta delivered with fundal massage and gentle downward traction on the cord.  Placenta appears intact and a three vessel cord is present. Pitocin infusion started to actively manage the third stage. Active bleeding noted. Uterine massage performed, small amount of clots evacuated from uterine cavity. 1g IV TXA administered. Active bleeding noted from left sided vaginal wall laceration, this was repaired in running locked fashion with 3-0 Vicryl and good hemostasis achieved. A shallow second degree perineal laceration was repaired in usual fashion using 3-0 vicryl. QBL 500 ml. Mother and baby remain skin to skin and bonding in the immediate postpartum period. Sponge, instrument and sharp counts were correct. Mother plans to breastfeed.