DESTRUCTIVE DELIVERY
Destructive delivery – also known as embryotomy – is used to deliver a dead fetus vaginally in a case of IUFD ( intra uterine fetal death).
It implies – as the word says – some sort of destroying or taking the fetus apart to facilitate delivery and protect the life of the mother.
There are in principle three acknowledged types of embryotomy:
1) Craniotomy – perforation of the skull and emptying the head of brain tissue so that the head collapses. That is used when the fetus presents with the head or in a case of retained head in a breech.
2) Decapitation – cutting the neck and separating the head from the truncus. That is used in a transverse presentation with following version and extraction on a foot (or both feet), as well as in the rare cases of locked twins.
3) Exvisceration – perforation of the truncus (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. Used when decapitation is not possible in a transverse presentation
Instruments for destructive delivery:
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From left to right: a perforator - a cranioclast - a hook - a pair of heavy scissors.
(The Basiostripe – not shown - is a very strong and powerful instrument which I however finding it clumsy and awkward never use)