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Destructive Operations

The document describes various destructive operations performed during obstructed labor when delivery of a dead fetus is not possible otherwise. It discusses craniotomy, decapitation, eviceration, and cleidotomy procedures in detail, including definitions, indications, steps, and complications. The goal of these operations is to diminish the bulk of the fetus to facilitate delivery through the birth canal when normal vaginal delivery is not feasible.

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680 views24 pages

Destructive Operations

The document describes various destructive operations performed during obstructed labor when delivery of a dead fetus is not possible otherwise. It discusses craniotomy, decapitation, eviceration, and cleidotomy procedures in detail, including definitions, indications, steps, and complications. The goal of these operations is to diminish the bulk of the fetus to facilitate delivery through the birth canal when normal vaginal delivery is not feasible.

Uploaded by

Secret Agent
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

Definition

The destructive operations are designed to

diminish the bulk of the fetus so as to

facilitate easy delivery through the birth

canal
Types

 Craniotomy

 Eviceration

 Decapitation

 Cleidotomy
CRANIOTOMY

 Definition

It is an operation to make a perforation on the fetal

head to evacuate the contents followed by extraction of

the fetus
Indications

 Cephalic presentation producing obstructed labour with

dead fetus

 Hydrocephalus even in a living fetus

 Interlocking head of twins


 Conditions to be fulfilled

 The cervix must be fully dilated

 Baby must be dead

 Contraindication

 When the pelvis is severely contracted

 Rupture of uterus where laparotomy is essential


Procedures
 PRELIMINARIES
 General anaesthesia

 Lithotomy position

 Surgical asepsis

 Empty the bladder

 Vaginal examination
Cont…

 ACTUAL STEPS

 Step 1

 Introduce two fingers into the vagina (index and


middle)

 Do incision through the suture line or dependent


part
Sites of perforation

 Vertex - On the parietal bone either side of the

sagittal suture

 Face -Through the orbit or hard palate

 Brow -Through the frontal bone


 Step 2

 Introduce the Oldham’s perforator or Sharp pointed


Mayo scissors with the blades closed

 Step 3

 By rotating movements perforate the skull

 Step 4

 Evacuate the brain matter with the fingers


Cont…
 Step 5
 Extract the fetus either by using a cranioclast or by
two giant volsella
 Step 6

 Exert traction

 Step 7

 Explore the utero-vaginal canal after the delivery


of the placenta
DECAPITATION

 Definition

It is a destructive operation whereby the fetal head

is severed from the trunk and the delivery is completed

with the extraction of the trunk and that of the

decapitated head per vaginam


Indication

 Neglected shoulder presentation with dead fetus where

neck is easily accessible

 Interlocking head of twins


PROCEDURE

 Actual Steps

 Step 1

 Bring down a hand and tie a roller gauze on the fetal wrist
and give traction towards the side away from the fetal head

 Step 2

 Two fingers of the left hand are introduced with palmar


surface downwards and the finger tips to be placed on the
superior surface of the neck.
Cont….
 Step 3

 The decapitation hook with knife is introduced flushed under


the guidance of the finger placed into the vagina the knob
pointing towards the fetal head

 The hook is pushed above the neck and rotated to 90 degree


so as to place the knife firmly against the neck

 The internal fingers are placed on the under surface of the


neck to guard the tip of the hook
Cont…
 Step 4
 By upward and downward movements of the hook with knife ,the
vertebral column is severed (evident by sudden loss of resistance)

 The rest of the soft tissue left behind may be severed by the same
instrument or by embryotomy scissors

 The decapitation hook is pushed up and rotated to 90 degree and


then to taken out under the guidance of the internal fingers

 The decapited head is pushed up and the trunk is delivered by


traction on the prolapsed arm
Cont…
 Step 5
 Delivery of the decapited head
 By hooking the index finger into the mouth
 By using crochet after fixing it with lower jaw
 By holding the severed neck with giant vulsellum and
delivery of the head as that of aftercoming head in breech
 Using forceps or following perforation after fixing the head
with forceps blades
 Step 6
 Routine exploration of the utero-vaginal canal to exclude
rupture of the uterus or any other injury
DECAPITATION USING BLOND- HEIDLER
THIMBLE AND WIRES SAW

 The neck is severed by the wire saw after passing the

wire loop around the fetal neck


EVISCERATION

 Definition

The operation consists in removal of thoracic and


abdominal contents piecemeal through an opening on
the thoracic or abdominal cavity at the most accessible
site
Indication

 Neglected shoulder presentation with dead fetus

 Fetal malformations ,such as fetal ascites or hugely

distended bladder or monsters


CLEIDOTOMY
 Definition

The operation consist of reduction in the bulk of the shoulder


girdle by division of one or both the clavicles

 Indications

 Dead fetus with shoulder dystocia

 Procedure

 The clavicles are divided by the embryotomy scissors or long


straight scissors introduced under the guidance of left two fingers
placed inside the vagina
POST OPERATIVE CARE

 Exploration of the utero-vaginal canal

 Self retaining catheter

 Dextrose saline drip

 Blood transfusion

 Ampicillin 500mg at 6 hours interval


COMPLICATION

 Injury to the utero-vaginal canal

 Post partum haemorrhage

 Shock

 Puerperal sepsis

 Subinvolution

 Injury to the adjacent viscera

 Prolonged ill health

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