CRANIOTOMY
In a case of IUFD when the presenting part of the dead fetus is the head a craniotomy is done. The skull is perforated with a sharp instrument – a perforator – and extracted either with a special forceps – a cranioclast – or with multiple heavy artery forceps applied to the scull. Sometimes an ordinary obstetrical forceps will do.
In case of face presentation the eye is a good entrance point for perforating the skull.
Technique:
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Using the perforator …… |
…the skull is perforated |
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The inner branch of the cranioclast…… |
..is applied inside the skull |
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The outer branch of the cranioclast is applied on the outside of the skull. Be aware that the cervix or other soft tissues does not get trapped! |
The two branches are assembled and the cranioclast is locked |
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Steady traction is applied. The brain is slowly squeezed out and the skull collapses |
Use slow and steady traction – no hurry! |
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Gradually the collapsed head …….. |
….is being extracted |
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The head …… |
….and shoulders are delivered as usual |
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The dead baby is delivered |
Carton box ready |
In case of a retained head in a breech the perforation is done via the occiput and the fetus is extracted the usual way.