DESTRUCTIVE OPERATIONS

DEFINITION
• The destructive operations are
designed to diminish the bulk of
the fetus so as to facilitate easy
delivery through the birth canal.

There are four types of Destructive
operations:
 Craniotomy
 Evisceration
 Decapitation
 Cleidotomy

CRANIOTOMY
DEFINITION
It is an operation to make a
perforation on the fetal head, to
evacuate the contents followed by
extraction of the fetus.

CRANIOTOMY

INDICATIONS
Cephalic presentation producing obstructed
labor with dead fetus.
Hydrocephalus even in a living fetus:
Interlocking head of twins.
CONDITIONS TO BE FULFILLED:
(1) The cervix must be fully dilated
(2) Baby must be dead

CONTRAINDICATIONS
(i) The operation should not be done
when the pelvis is severely
contracted
(ii) Rupture of the uterus where
laparotomy is essential.

DECAPITATION
DEFINITION
It is a destructive operation whereby
the fetal head is severed from the
trunk and the delivery is completed
with the extraction of the trunk and
that of the decapitated head per
vaginam.

DECAPITATION

INDICATIONS:
(1)Neglected shoulder with dead fetus
where neck is easily accessible;
(2)Interlocking head of twins.

EVISCERATION
• The operation consists of removal of thoracic
and abdominal contents through an opening
on the thoracic or abdominal cavity at the
most accessible site. The object is to
diminish the bulk of the fetus which
facilitates its extraction.

EVISCERATION

INDICATIONS
Neglected shoulder presentation with
dead fetus.
 Fetal malformations, such as fetal ascites
or hugely distended bladder.

CLEIDOTOMY
The operation consists of reduction in the
bulk of the shoulder girdle by division of
one or both the clavicles. The operation is
done only in dead fetus with shoulder
dystocia.

CLEIDOTOMY

• The clavicles are divided by the
embryotomy scissors or long straight
scissors introduced under the guidance of
left two fingers placed inside the vagina.

POSTOPERATIVE CARE FOLLOWING
DESTRUCTIVE OPERATIONS
Exploration of the uterovaginal canal must be
done to exclude rupture of the uterus or
lacerations on the vagina or any genital injury
. A self-retaining (Foley's) catheter is put
inside, espe cially following craniotomy for a
period of 3-5 days or until the bladder tone is
regained.

Dextrose saline drip is to be continued till
dehydrationis corrected. Blood
transfusion may be given, if required.
 Ceftriaxone 1 g IV infusion is given
twice daily.

COMPLICATIONS
• (1) Injury to the uterovaginal canal
• (2) Rupture of uterus
• (3) Postpartum hemorrhage-atonic or
traumatic;
• (4) Shock-due to blood loss and/or
dehydration.

• (5) puerperal sepsis
• (6) Subinvolution
• (7) Injury to the adjacent viscera- bladder-
vesicovaginal fistula or rarely to rectal wall
leading to rectovaginal fistula
• (8) Prolonged ill health