one of the obstetrical operations

1. WELCOME

2. By
Mrs.Jasmi Manu
Head of the department(OBS/GYN) Nursing
Rama college of Nursing
Rama University, Kanpur

3. INTRODUCTION
 Obstetric operations are surgical procedures and
such irrespective of the nature of operation (major
or minor),asepsis and antiseptic precaution are to
be taken as outlined.
 Even an internal examination during late
pregnancy and labour utmost asepsis. The
proximity of the bladder and rectum to the operative
field should deserve attention prior to any operative
procedure.

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

5. TYPES OF DESTRUCTIVE OPERATION
 Craniotomy
 Evisceration
 Decapitation
 Cleidotomy

6. CRANIOTOMY
 Definition
“It is an operation to make a perforation on the fetal
head, to evacuate the contents followed by
extraction of the fetus.”
Indication
1. Cephalic presentation producing obstructed labour
with dead fetus- this is the commonest indication
of craniotomy in the referral hospital of the
developing countries.
2. Hydrocephalus even in a living fetus- This is a
applicable both for the fore-coming and the after-
coming head.
3. Interlocking head of twins

7. CONDITIONS TO BE FULFILLED :
1. The cervix must be fully dilated
2. Baby must be dead ( hydrocephalus being
excluded)
Contraindication
I. The operation should not be done when the
pelvis in severely contracted so as to shorten
the true conjugate to less than 7.5 cm (3). In
such condition baby can not delivered, as the
bimastoid diameter( base of skull ) of 7.5 cm can
not be compressed.
II. Rupture of the uterus where laparotomy is
essential

10. 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
1. Neglected shoulder presentation with dead fetus
where neck is easily accessible.
2. Interlocking head of twins.

12. EVISCERATION
Definition
“ The operation consists of removal of thoracic and
abdominal contents piecemeal through an opening
on the thoracic or abdominal cavity at the most
accessible site.
Indication
1. Neglected shoulder presentation with dead fetus;
the neck is not easily accessible
2. Fetal malformation, such as fetal ascites or
hugely distended bladder or monsters.

16. POST OPERATIVE CARE FOLLOWING
DESTRUCTIVE OPERATION
 Exploration of the utero- vaginal canal must be
done
 A self retaining (folley’s) catheter is put inside
 Dextrose saline drip is to be continued
 Ceftriaxone

17. CLEIDOTOMY
 DEFINITION
The operation consist of reduction in the bulk
of the shoulder girdle by division of one or both the
clavicles.

18. COMPLICATION
1. Injury to the utero-vaginal canal
2. Rupture of uterus
3. Postpartum hemorrhage , atonic or traumatic
4. Shock- due to blood loss and/or dehydration
5. Puerperal sepsis
6. Sub involution
7. Injury to the adjacent viscera-bladder– vesico-
vaginal fistula or rarely to rectal wall leading to
recto-vaginal fistula
8. Prolonged ill health.