Destructive Operations /Embryotomy/
It may occasionally be necessary, in the interest of saving the mother's life, to destroy the fetus. These drastic measures will only be undertaken if there is gross fetal abnormality causing fetal pelvic disproportion. The alternative is caesarean section. The fetus may be equally difficult to deliver abdominally and may still need to be destroyed first. What ever the situation it is traumatic for all concerned and calls for sensitive support of both the family and the staff.
The instruments used for destructive operations are of necessity brutal and must be used with great care to avoid injuring the mother.
The main operations are; Decapitation, craniotomy, evisceration and cleidotomy.
Decapitation – may be necessary when a shoulderpresentation has become impacted. There are also varioustypes of decapitating hooks and knives which may be encountered. The operation consists of severing the fetal head from the trunk, followed by extraction, per vaginam, of the trunk and finally of the head. The procedure is done when the child is dead and the cervix fully dilated.
Craniotomy – By perforating the fetal head allowing the brainto escape the volume of the skull is reduced, and the cranial bores collapse, permitting delivery. Performed most commonly for hydrocephalus or of disproportion due to an unfavorable position of the child, such as brow or mentoposterior position in which death of the fetus has occurred.
Evisceration – It may be necessary to remove the abdominalor thoracic contents in some cases of gross fetal abnormality. If the presentation is cephalic this is difficult but it is more feasible in a breech presentation. The abdomen or chest is opened using a perforator and the contents removed manually.
Cleidotomy – In this procedure the clavicles are cut to reducethe width of the shoulder girdle and may be required when large shoulders prevent delivery of the child, which has died during the attempt.
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