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
The destructive operations are designed to
diminish the bulk of the fetus so as to
facilitate easy delivery through the birth
canal

3. Types
• Craniotomy
• Eviceration
• Decapitation
• Cleidotomy

4. CRANIOTOMY
• Definition
It is an operation to make a perforation on the
fetal head to evacuate the contents followed by
extraction of the fetus

7. Simpson Perforator

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

9. Indications
• Cephalic presentation producing obstructed
labour with dead fetus
• Hydrocephalus even in a living fetus
• Interlocking head of twins

10.  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

11. Procedures
PRELIMINARIES
General anaesthesia
Lithotomy position
Surgical asepsis
Empty the bladder
Vaginal examination

13. Cont…
ACTUAL STEPS
Step 1
Introduce two fingers into the vagina (index and
middle)
Do incision through the suture line or dependent
part

14. 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

16.  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

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
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

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
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

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