EMBRIOTOMY Destructive Vaginal Delivery

Prof. dr. Mgs. H. Usman Said, SpOG (K)

Subbagian Fertilitas Endokrinologi & Reproduksi Departemen Obstetri & Ginekologi FK. Unsri / RSUP Dr. Muhammad Hoesin Palembang 2010
1

 Definition : Definition Reductive surgical procedure performed on the dead fetus to reduce its size and make vaginal delivery possible. Important features :Important features Need few instruments Leaves the mother with intact uterus If she is already infected risk of spread of infection to the peritoneum low Shorter time in bed
2

TYPES:
Craniotomy Decapitation Evisceration Cleidotomy

 Rate of DVD in Eth. : Study done in TAH (1997-2002) 7.8 DVDs per 1000 deliveries Craniotomy (94%) for CPD(89%)
Average BW -2957gm GA 31-45 wkspreterm(13%), post term (7%) & term(54%) Labor >24hrs in 88% Fistulas , infection & genital trauma Currently almost never practiced in the developed world
4

 Indications of DVD : CPD, Breach delivery, Transverse lie Prerequisites for DVD : Dead fetus exceptions(malformation or tumor incompatible with life, Cleidotomy & needle aspiration for hydrocephalus) Fully dilated cervix No risk of uterine rupture 2/5 or less of his head must be above the brim Back up operative facilities
5

CONTRAINDICATIONS OF DVD
Live fetus Markedly contracted pelvis ( conjugate vara <5.5cm) Cervix <7cm dilated Obstructing pelvic tumors Imminent uterine rupture
6

CRANIOTOMY
Perforation of the skull and emptying the head of brain tissue so that the head collapses. It is used when the fetus presents with the head or in a case of retained head in a breech. Indications - obstructed labor with a vertex or face presentation - arrested aftercoming head - hydrocephalus- Interlocked head of twins - contracted pelvis is the most common indication7

 Scalp is held with a tissue forceps and incision is made with a perforator and contents of the brain are evacuated. Sites-vertex-parietal bone -face-orbit/hard palate -brow-frontal bone -aftercoming headforamen magnum

 Hydrocephalus - forecoming head- a large needle is inserted near the suture line and fluid is drained aftercoming head-after delivery of the shoulder base of the skull is exposed & fluid is drained or transabdominal encephalocentesis can be done
10

DECAPITATION
IS cutting the neck and separating the head from the truncus followed by version and extraction Ind. - obstructed labor in shoulder presentation when the neck is easily accessible, as well as in the rare cases of locked twins Instruments- decapitating wire & Blondheidler thimble
11

12

EVISCERATION
IS perforation of the truncus (chest or abdomen) with removal of all internal organs so that the body collapses and a version and extraction can be done without the risk of rupturing the uterus. Ind-in shoulder presentation where it is difficult to reach the neck - fetal malformation(ascites, huge distended bladder, hydronephrosis) - after decapitation
13

Procedure - pull on the prolapsed arm & his axilla protect the vaginal wall with speculum - make an opening in the chest or abd. Wall - remove the viscera (liver, heart, and lungs) If necessary perforate his diaphragm with scissors.
14

CLEIDOTOMY
Cutting of one or both clavicles to reduce the width of the shoulder This is considered in cases where the head is delivered, large shoulders are obstructing delivery and other maneuvers for shoulder dystocia have been unsuccessful Ind- fetus with shoulder dystocia Skin at the base of the pos. is perforated &opening is made to gain access to the clavicle. 15 Clavicle is cut and the baby is delivered.

COMPLICATIONS
Trauma to birth canal PPH Shock Puerperal sepsis Injury to adjacent organs VVF,UVF or RVF Iatrogenic Ux rupture
16