Obstetrics and Gynecology - A. M. Hromova 2000

Operative Obstetrics
Fetal Destructive Operations
Decapitation

Decapitation is an obstetric Procedure involving the Separation of the fetal HEAD from

the fetal trunk at the level of the cervical spine, followed by their extraction through the natural birth canal.

Indications: neglected transverse lie of the fetus.

Prerequisites for decapitation:

- full cervical dilation;

- accessibility of the fetal neck;

- pelvic dimensions sufficient for the passage of the fetus.

Required instruments: Braun decapitation hook, Siebold or Phenomenov scissors, Museux forceps.

The procedure must be performed under general anesthesia. The Urinary Bladder must be emptied prior to the operation.

The surgical technique consists of three stages:

Stage 1 - insertion and positioning of the decapitation hook. This comprises three steps:

1. Grasping the prolapsed arm by an assistant and pulling it to the side opposite to the Location OF THE head; if the arm has not prolapsed, the procedure begins with the second step.

2. Introduction of the hand into the Vagina and grasping the fetal neck.

3. Insertion and placement of the decapitation hook.

Stage 2 - the decapitation itself. First, by rotating the hook 90 degrees, the cervical vertebrae are fractured, and then, under the guidance of the internal hand, the soft Tissues of the fetal neck are divided using scissors. Meanwhile, the decapitation hook is pulled down toward the pelvic outlet.

Stage 3 - extraction of the dismembered fetus. By traction on the arm, the trunk is extracted relatively easily. During the delivery of the head, it is fixed by an assistant at the pelvic brim using external maneuvers, after which vaginal specula are inserted, the head is grasped with Museux forceps, and its extraction is initiated. Whenever possible, it is delivered by manual maneuvers. If difficulties arise during manual extraction, the head is perforated, followed by excerebration and cranioclasis.