Obstetrics and Gynecology - A.M. Gromova 2000

Operative Obstetrics
Destructive Fetal Operations

The current application of destructive obstetric operations is dictated by the need to choose the safest delivery route following intrauterine fetal death or in the presence of a viable fetus with severe Congenital Malformations.

Destructive operations are defined as Procedures aimed at reducing the size of fetal parts to dimensions that allow passage through the natural birth canal.

Destructive operations are divided into 3 groups:

1. Procedures that reduce fetal volume (Craniotomy, Evisceration).

2. Procedures involving fetal dismemberment and piecemeal extraction (Decapitation, Spondylotomy, and exarticulation).

3. Procedures that reduce fetal volume by maximizing the mobility between individual body parts (Cleidotomy, cranial puncture in Hydrocephalus, limb bone fractures).

Operations are traditionally classified According to the fetal presentation at the time of the Procedure:

1. In longitudinal cephalic presentation (craniotomy, cleidotomy).

2. In longitudinal breech presentation (perforation of the aftercoming HEAD).

3. In neglected transverse lie (decapitation).

4. In transverse or oblique lie (evisceration, eventeration, spondylotomy).

The most frequently performed procedures include craniotomy, decapitation, and cleidotomy, while other operations are rarely encountered in clinical practice.

5. Craniotomy is the reduction of the fetal head volume followed by its extraction in a reduced state.

6. Decapitation is the severance of the fetal head in a neglected transverse lie.

7. Cleidotomy is the transection of one or both clavicles to reduce the diameter of the shoulder girdle.

8. Spondylotomy is the transection of the vertebrae.

9. Evisceration and eventeration involve the removal of the thoracic and abdominal viscera.



Last update: 08/08/2026

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