Plodorodnoye operations

Plodorodnoye operations - operative interventions aiming to reduce the size of the fetus to the size, creates the possibility of its passing through the birth canal. Plodorodnoye operations are performed, as a rule, on a dead fetus and only in exceptional cases (the inability the birth of a fetus through the birth canal and the lack of conditions for delivery of a woman using operations, preserving the life of the fetus) valid operation on a live fetus.
Craniotomy - reducing the size of the head of the fruit. Indications: narrow pelvis, adverse presentation and inserting head when childbirth is impossible (rear view of the front presentation, execution previa, zaznamenano inserting), narrowing soft generic ways scars or tumor. Conditions for craniotomy: opening of the fallopian OS 3.5-4 cross-thumb fixation of the head, the lack of absolute narrow pelvis (true conjugate should be more than 6,5 cm).
To perform a craniotomy need the following tools: vaginal mirrors, bullet forceps, spear or trepanobiopsy hammer, a large curette, catheter double current, kranichrast.


Fig. 1. Perforation predlagay head on Fenomenov.

Fig. 2. The imposition of kranichrast on predlagayu head: 1 - introduction"internal" branches, the fixation of the head (the first time); and 2) the introduction of "male" branches, the pressure on the crown weakened (the second time).

Fig. 3. The decapitation hook brown. Fig. 4. Removing a severed head.

Operation craniotomy consists of three stages: perforation of the head (Fig. 1), aksceleracija (removal of the brain) and chroniclethe (compression and extraction head). Operation is performed under General anesthesia. Before operation it is necessary to empty the bladder, disinfecting external genitals and make a thorough external and internal obstetric investigation (see).
Usually perforation head produced under the control of view. The great value has good fixation of the head to the entrance of the small pelvis. After the formation of the hole in the skull of the substance of the brain erode and wash away. The final stage craniotomy is squeezing perforated head and removing vaginal delivery through kranichrast, one branch of which is injected into the cavity of the skull, the second impose on the outside of the head (Fig. 2). When performing perforation head and kranichsee should be wary avoid injuries of soft tissues and neighboring organs of the woman.
Embryotomy - cut fruit and extract it in parts. The indication to embryotomy most often is running lateral position of the fetus. Conditions for embryotomy: no absolute narrow pelvis, the disclosure of uterine throat for 3 cross fingers. Contraindications to embryotomy is started rupture of the uterus. Embryotomy is always under anesthesia. Before operation it is necessary to empty the bladder and rectum. When running cross the fetal position with a fallen handle produce decapitation (cutting off the head of the fruit from the body), with other variants provisions fruit - evisceration (reduced fruit size by removing its innards) or spondilite (dissection of the spine).
For decapitaci necessary decapitazioni hook brown, scissors Fenomenov or sibolga. Operation is carried out under the control of introduced into the uterus hands, which cover the neck of the fetus. Using decapitazione hook carry out a fracture of the cervical spine (Fig. 3), soft tissue cut with scissors. After cutting off the head, the trunk can easily retrieve the handle. Head deduce manual techniques (Fig. 4). If it is impossible to achieve hand neck of the fetus resort to the evisceration and spongillidae. In these cases embryotomy the most difficult. Cladonia (crossing clavicles) is used in the difficulty of removing the shoulders of the fetus. Clavicle cut with scissors with one or two sides, after which the removal of the trunk is no problem.
Due to the great risk of damage to the generic ways in plodorozsadnyk operations recommended after the removal of the fruit producing a manual examination of the uterus, carefully examine the vagina and cervix in mirrors, perform catheterization of the bladder.
In the postpartum period in puerperas who underwent plodorodnoye operation, it is necessary to conduct preventive antibiotic treatment because of the risk of developing postnatal septic diseases.

Plodorodnoye operation is a complex of operational procedures that minimise the amount of fruit to the size, enabling it passes through the birth canal of the mother. Currently plodorodnoye operations are performed only on a dead fetus and only in exceptional cases on the living.
Depending on the specific position and the presentation of the fetus used craniotomy or embryotomy.
Complications when plodorozsadnyk operations: wounds of soft tissues in the slippage of the instruments used for these operations, often perforator; tears of cervix of the uterus and other soft tissues of the generic ways, rupture of the uterus, damage to the urinary tract. Because of the damage and injury at plodorozsadnyk operations can be significant, recommend that immediately after the removal of the fruit examine the vagina and cervix mirror, be sure to make a manual examination of the uterus and catheterization.
During the postpartum period in puerperas who underwent plodorodnoye operation, often complicated by postnatal septic diseases. So with prolonged rupture of membranes, extensive injuries generic ways shows the prophylactic use of antibiotics and sulfa drugs as in childbirth, and in the first 4-5 days postpartum period.