Destructive operation

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
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
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

1. PRANATI PATRA

2. Definition
Thedestructiveoperationsaredesignedto
diminishthebulkofthefetussoasto
facilitateeasydeliverythroughthebirth
canal

3. Types
•Craniotomy
•Eviceration
•Decapitation
•Cleidotomy

4. CRANIOTOMY
•Definition
Itisanoperationtomakeaperforationonthe
fetalheadtoevacuatethecontentsfollowedby
extractionofthefetus

7. Simpson Perforator

8. Cranioclast forcep -used to extract fetus after
perforation and decompression of head

9. Indications
•Cephalicpresentationproducingobstructed
labourwithdeadfetus
•Hydrocephaluseveninalivingfetus
•Interlockingheadoftwins

10. Conditionstobefulfilled
Thecervixmustbefullydilated
Babymustbedead
Contraindication
Whenthepelvisisseverelycontracted
Ruptureofuteruswherelaparotomyisessential

11. Procedures
PRELIMINARIES
Generalanaesthesia
Lithotomyposition
Surgicalasepsis
Emptythebladder
Vaginalexamination

13. Cont…
ACTUALSTEPS
Step1
Introducetwofingersintothevagina(indexand
middle)
Doincisionthroughthesuturelineordependent
part

14. Sites of perforation
Vertex-Ontheparietalboneeithersideofthe
sagittalsuture
Face-Throughtheorbitorhardpalate
Brow-Throughthefrontalbone

16. Step2
IntroducetheOldham’sperforatoror
SharppointedMayoscissorswiththe
bladesclosed
Step3
Byrotatingmovementsperforatethe
skull
Step4
Evacuatethebrainmatterwiththe
fingers

17. 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

18. DECAPITATION
Definition
Itisadestructiveoperationwherebythefetal
headisseveredfromthetrunkandthedeliveryis
completedwiththeextractionofthetrunkand
thatofthedecapitatedheadpervaginam

26. DECAPITATION HOOK WITH KNIFE

28. Indication
•Neglected shoulder presentation with dead fetus
•Fetal malformations ,such as fetal ascites or
hugely distended bladder

29. Embryotomy scissors –used to cut the thoracic cage or
abdominal cavity during evisceration

30. CLEIDOTOMY
Definition
Theoperationconsistofreductioninthebulkoftheshoulder
girdlebydivisionofoneorboththeclavicles
Indications
Deadfetuswithshoulderdystocia
Procedure
Theclaviclesaredividedbytheembryotomyscissorsorlong
straightscissorsintroducedundertheguidanceoflefttwofingers
placedinsidethevagina

31. Embryotomy scissors –used to cut the thoracic cage or
abdominal cavity during evisceration

33. POST OPERATIVE CARE
•Exploration of the utero-vaginal canal
•Self retaining catheter
•Dextrose saline drip
•Blood transfusion
•Ampicillin 500mg at 6 hours interval

34. COMPLICATION
•Injury to the utero-vaginal canal
•Post partum haemorrhage
•Shock
•Puerperal sepsis
•Subinvolution
•Injury to the adjacent viscera
•Prolonged ill health