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    10 Destructive Delivery

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    Bright Kumwenda
    10 Destructive Delivery

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    10 Destructive Delivery

    Uploaded by

    Bright Kumwenda
    6 views4 pages
    10 Destructive Delivery

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    © © All Rights Reserved

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    RTF, PDF, TXT or read online from Scribd

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    10 Destructive Delivery

    Copyright:

    © All Rights Reserved
    Download as RTF, PDF, TXT or read online from Scribd
    Download as rtf, pdf, or txt
    6 views4 pages

    10 Destructive Delivery

    Uploaded by

    Bright Kumwenda
    10 Destructive Delivery

    Copyright:

    © All Rights Reserved
    Download as RTF, PDF, TXT or read online from Scribd
    Download as rtf, pdf, or txt
    of 4

    DESTRUCTIVE DELIVERY/OPERATIONS

    By Laston Kastom,BscBMS(RH),Dip.Clin.Med

    INTRODUCTION

    You should try not to do caesarean section for obstructed labour, if the baby is already dead. In most
    cases destructive operation is easier and safer, because it carries less risk of bleeding and infection and
    also because it leaves no uterine scar. However, for a destructive operation to be safe, three points
    should always be observed, and these are;

     The indication of the operation must be correct


     You should follow the correct operative technique
     You should be able to do an immediate laparatomy when you discover a rupture of the uterus
    during the operation

    The commonest destructive operations done include craniotomy, craniocentesis and decapitation and
    evisceration

    CRANIOTOMY

    This is a procedure where by the fetal skull is perforated.

    It can be done when the fetus is presenting cephalically even when the fetus is presenting in a breech.

    INDICATIONS OF CRANIOTOMY

     If the fetus is dead


     2/5 or less of the head is above the brim ( if the head is higher caesarean section is usually safer)
     The cervix is fully dilated
     The uterus is not ruptured

    ACTUAL PROCEDURE OF CRANIOTOMY ON A CEPHALIC PRESENTATION

     Review general care principles and apply antiseptic solution to the vagina
     Perform an episiotomy
     Make a cruciate (cross-shaped) incision on the fetal scalp
     Open the cranial vault at the lowest and most central bony point with a craniotome (or a large
    pointed scissors or a heavy scalpel). In the face presentation, perforate the orbits.
     Insert the craniotome into the fetal cranium and fragment the intracranial contents
     Grasp the edges of the skull with several heavy-toothed forceps (e.g. Kocher) and apply traction
    in the axis of the birth canal.
     As the head descends, pressure from the bony pelvis will cause the skull to collapse, decreasing
    the cranial diameter.
     If the head is not delivered easily, perform caesarean section
     After delivery, examine the woman carefully and repair any tear to the cervix, or vagina or repair
    the episiotomy
     Ensure adequate fluid intake and urinary output

    CRANIOTOMY IN A BREECH PRESENTATION WITH ENTRAPPED HEAD

     Make an incision through the skin at the base of the neck.


     Insert a craniotome (or large pointed scissors or a heavy scalpel) through the incision and tunnel
    subcutaneously to reach the occiput
     Perforate the occiput and open the gap as widely as possible
     Apply traction on the trunk to collapse the skull as the head descends

    CRANIOCENTESIS

    This is a procedure where by the fetal skull is puncture. It can be performed through the vagina or
    through the abdominal wall.

    The main indication of craniocentesis is when the fetus has hydrocephalus.

    ACTUAL PROCEDURE OF CRANIOCENTESIS

     Review general care principles and apply antiseptic solution to the vagina
     Then make a large episiotomy, if required

    IN A FULL DILATED CERVIX

     Pass a large-bore spinal needle through the dilated cervix and through the sagittal suture line or
    fontanelles of the fetal skull
     Aspirate the cerebrospinal fluid until the fetal skull has collapsed, and allow normal delivery to
    proceed.

    IN A CLOSED CERVIX

     Palpate for location of the fetal head


     Apply antiseptic solution to the suprapubic skin
     Pass a large spinal needle through the abdominal and uterine walls and through the
    hydrocephalic head.
     Aspirate the cerebrospinal fluid until the fetal skull has collapsed, and then allow normal delivery
    to proceed.

    CRANIOCENTESIS AND AFTERCOMING HEAD DURING BREECH DELIVERY

     After the rest of the body has been delivered, insert a large-bore spinal needle through the
    cervix and foramen magnum
     Aspirate the cerebrospinal fluid and delivery the aftercoming head as in breech delivery.
    DECAPITATION

    This is the procedure where by the fetus’ neck is divided and the body and the head are then delivered
    separately.

    INDICATIONS

     If the fetus is dead


     If the lie is transverse
     If the cervix is 8cm or above
     If the uterus is not ruptured

    CONTRA-INDICATIONS

     Do not attempt decapitation or evisceration through the vagina if the fetus is still high in the
    birth canal. It is dangerous because you will not be able to protect the vaginal wall and cervix
    adequately during the operation.
     Ruptured uterus
     Cervical dilatation of less than 8 cm

    ACTUAL PROCEDURE OF DECAPITATION

     Give anaesthesia as of craniotomy


     Put the patient in lithotomy
     Clean and drape the vulva
     Catheterize the bladder
     Do a thorough vaginal examination the exact position of the fetus; locate the arm that is
    prolapsing, position of the head and the neck, and also that of the chest, abdomen and the back.
     Take a decapitation saw, hook the end of the saw in a thimble
     Put the thimble on the best finger of your best hand and try to bring it around the neck. This is
    often difficult because there is little room between the neck, the head and the chest.
     When the saw is in position, protect the vagina with specula
     Apply firm traction and saw through the neck
     Pull on the arm to deliver the body
     Put a hand in the vagina and turn the head so that the neck points downwards
     Put one or more volsellum forceps on the neck and deliver the head like the aftercoming head of
    a breech.
     If the head was delivered first, deliver the body by pulling on other arm. Don’t do a version,
    because the cut neck might damage the uterus.

    COMPLICATIONS OF THE DESTRUCTIVE OPERATIONS

     Puerperal sepsis
     Uterine rupture
     Vaginal trauma
     Cervical trauma
     Postpartum haemorhage
     Laparatomy

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