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
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
15.
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 vulsella
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
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
32.
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