The operation by which a reduction in the volume of the present or subsequent head is achieved, followed by its removal in a reduced form. It can be performed on the dead, in exceptional cases - on the live fruit.
Indications for craniotomy:
1. The presence of a dead or non-viable fetus with severe developmental defects in clinically or anatomically narrow pelvis, weakness of labor, cicatricial narrowing of the vagina, tumors of the vagina, which leads to excessive procrastination.
2. Threat to the life of the mother with a dead fetus, unfavorable insertion of the head, frontal presentation, litsmanivskomu insertion of the head and the absence of conditions for cesarean section, vacuum extraction of the fetus or the imposition of obstetric forceps.
3. The condition of the mother, which requires immediate delivery (cardiovascular disease, eclampsia, some cases of premature placental abruption, etc.). In conditions of a dead fetus.
Indications of craniotomy with a live fetus appear very rarely - only in those situations in which immediate delivery is shown, and there are no conditions to perform cesarean section. These include the same indications as when a dead fetus.
Conditions for craniotomy:
1. Opening of the uterine pharynx not less than 6 cm.
2. Absence of a fetal bladder.
3. Dead fruit.
4. The size of the true conjugate is not less than 6.5 cm.
5. The fetal head is fixed to the entrance to the small pelvis.
Necessary tools: vaginal mirrors, bullet forceps or Myso forceps, Volkmann spoons or curettes, Blok puncher, cranioclast, Zyboldt scissors or Phenomenov scissors.
The operation is performed under general anesthesia. Before the operation, it is necessary to empty the bladder and disinfect the external genitalia and vagina.
The technique of the operation consists of three stages:
1. Perforation of the head.
Perforation of the head is performed in this position of the woman, which is used for all vaginal operations, and consists of the following moments:
1. Introduction of mirrors in the vagina and exposure of the head.
2. Grasping the scalp with forceps and fixing it.
3. Perforation proper.
Perforation of the head
The skin of the fetal head between the forceps is dissected transversally by scissors and slightly exfoliated from the bones of the skull. Under the control of vision, the perforator is inserted into the seam or fontanel assembly and taken out into an open, expanding perforation. With facial presentation, perforation is performed through the mouth, with the frontal - through the orbit, with the further head - through the large occipital opening.
The operation of excrement is aimed at extracting the medullary substance through the perforation. First, the curette is destroyed by the brain, and then removed with a large curette.
Cranioclasia is the operation of extraction of perforated and reduced in the volume of the head with the help of cranioclast. If there is no such need, they are limited to perforation and ekscherebracii, after which the fetus itself is born.
The operation consists of three moments:
- Introduction and placement of cranioclast spoons (first introduce the inner spoon through the perforation by convexity facing the face, the second - the outer spoon, according to the same rules as the first spoon, and place it on the face);
- Closing of branches;
- Seizure of the head (the nature and direction of traction are the same as with obstetric forceps).
Perforation of the subsequent head is made after the unsuccessful application of manual allowance at
dead fetus or hydrocephalus.