This document defines and describes various destructive obstetric operations performed to facilitate delivery of a dead fetus through the birth canal when the fetus cannot pass due to obstruction. These operations include craniotomy, evisceration, decapitation, and cleidotomy. Craniotomy involves perforating the fetal head to evacuate contents. Evisceration removes thoracic and abdominal contents. Decapitation severs the head from the trunk. Cleidotomy divides the clavicles to reduce shoulder bulk. Postoperative care and complications are also outlined.
This document defines and describes various destructive obstetric operations performed to facilitate delivery of a dead fetus through the birth canal when the fetus cannot pass due to obstruction. These operations include craniotomy, evisceration, decapitation, and cleidotomy. Craniotomy involves perforating the fetal head to evacuate contents. Evisceration removes thoracic and abdominal contents. Decapitation severs the head from the trunk. Cleidotomy divides the clavicles to reduce shoulder bulk. Postoperative care and complications are also outlined.
This document defines and describes various destructive obstetric operations performed to facilitate delivery of a dead fetus through the birth canal when the fetus cannot pass due to obstruction. These operations include craniotomy, evisceration, decapitation, and cleidotomy. Craniotomy involves perforating the fetal head to evacuate contents. Evisceration removes thoracic and abdominal contents. Decapitation severs the head from the trunk. Cleidotomy divides the clavicles to reduce shoulder bulk. Postoperative care and complications are also outlined.
designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal. There are four types of Destructive operations: Craniotomy
Evisceration 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. CRANIOTOMY INDICATIONS
Cephalic presentation producing obstructed
labor with dead fetus. Hydrocephalus even in a living fetus:
Interlocking head of twins.
CONDITIONS TO BE FULFILLED:
(1) The cervix must be fully dilated
(2) Baby must be dead
CONTRAINDICATIONS
(i) The operation should not be done
when the pelvis is severely contracted (ii) Rupture of the uterus where laparotomy is essential. 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. DECAPITATION INDICATIONS:
(1)Neglected shoulder with dead fetus
where neck is easily accessible; (2)Interlocking head of twins. EVISCERATION • The operation consists of removal of thoracic and abdominal contents through an opening on the thoracic or abdominal cavity at the most accessible site. The object is to diminish the bulk of the fetus which facilitates its extraction. EVISCERATION INDICATIONS
Neglected shoulder presentation with
dead fetus. Fetal malformations, such as fetal ascites or hugely distended bladder. CLEIDOTOMY The operation consists of reduction in the bulk of the shoulder girdle by division of one or both the clavicles. The operation is done only in dead fetus with shoulder dystocia. CLEIDOTOMY • The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina. POSTOPERATIVE CARE FOLLOWING DESTRUCTIVE OPERATIONS
Exploration of the uterovaginal canal must be
done to exclude rupture of the uterus or lacerations on the vagina or any genital injury . A self-retaining (Foley's) catheter is put inside, espe cially following craniotomy for a period of 3-5 days or until the bladder tone is regained. Dextrose saline drip is to be continued till dehydrationis corrected. Blood transfusion may be given, if required. Ceftriaxone 1 g IV infusion is given twice daily. COMPLICATIONS
• (1) Injury to the uterovaginal canal
• (2) Rupture of uterus
• (3) Postpartum hemorrhage-atonic or traumatic;
• (4) Shock-due to blood loss and/or dehydration.
• (5) puerperal sepsis
• (6) Subinvolution
• (7) Injury to the adjacent viscera- bladder-
vesicovaginal fistula or rarely to rectal wall leading to rectovaginal fistula • (8) Prolonged ill health