Part 14

DESTRUCTIVE VAGINAL
DELIVERY (DVD)
By sr. Luchia Araya
RMW,BSC, MSC
DESTRUCTIVE VAGINAL DELIVERY
(DVD)

• Definition : Reductive surgical procedure performed on the dead

fetus to reduce its size and make vaginal delivery possible.
• 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
• Types : 
• Craniotomy Decapitation
• Evisceration Cleidotomy
• Indications of DVD: CPD, Breach presentation, 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
Contraindication of DVD : 

• Live fetus
• Markedly contracted pelvis (conjugate vara <5.5cm) Cervix <7cm
dilated
• Obstructing pelvic tumors
• Imminent uterine rupture
• 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 after-coming head
• Hydrocephalus
• interlocked head of twins –
• contracted pelvis is the most common indication
• Procedure:
• Scalp is held with a tissue forceps
• incision is made with a perforator
• contents of the brain are evacuated.
• Sites:
• vertex-parietal bone
• face-orbit/hard palate
• brow-frontal bone
• aftercoming head-foramen 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.
• DECAPITATION : Cutting the neck and separating the head from
the truncus followed by version and extraction
• Indication:
• obstructed labor
• shoulder presentation (when the neck is easily accessible)
• Locked twins
• Instruments: decapitating wire & Blond- heidler thimble
• EVISCERATION : perforation of 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.
• Indication:
• Shoulder presentation where it is difficult to reach the neck –
• Fetal malformation (ascites , huge distended bladder ,
hydronephrosis)
• After decapitation
• 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
• CLEIDOTOMY : Cutting of one or both clavicles to reduce the width of
the shoulder
• Indication:Where the head is delivered, large shoulders are obstructing
delivery
• Other maneuvers for shoulder dystocia have been unsuccessful
• Procedure:
• fetus with shoulder dystocia ---
• Skin at the base is perforated
• opening is made to gain access to the clavicle.
• 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