DECAPITATION of a fruit (Latin the de-prefix extraction, destruction + caput, capit[is] the head) — the obstetric fetaldestructive operation consisting in separation at a fruit of a head from a trunk for the purpose of its reduction to the sizes giving the chance of passing on patrimonial ways.
By it was applied in the ancient time. So, Hippocrates's school (4 — 5 centuries BC) used special tools for a partition of a fruit on a part. A. Tsels (1 century BC) wrote about operation of cutting off of a head from a trunk at the cross provision of a fruit. Among other fetaldestructive operations was widely adopted in the Middle Ages. However use of such operations was considerable is limited after A. Paré's resuming (16 century) operations of obstetric turn (see).
In our country the number of fetaldestructive operations, including and D., considerably decreased as a result of creation of wide network to lay down. - professional, institutions, active patronage observation of pregnant women and women in labor in the conditions of regional clinics for women, improvement of the technology of Cesarean section, and also use of modern types of anesthesia. All this allows or to improve cross situation of a fruit, or to timely make operation Cesarean section (see).
Indications and contraindications
the Indication most often is the started cross situation with the dropped-out handle at a dead fruit. Only in extremely exceptional cases, in the absence of conditions for Cesarean section, D. is made on a live fruit. Less often D. is applied at a collision of twins, and also at an accrete twin (see. Polycarpous pregnancy ). At the menacing hysterorrhesis and the cross provision of a fruit of D. it is possible to make only at easy access to a neck of a fruit and its small sizes.
Sometimes at the started cross situation D. it is not shown owing to unavailability of a neck of a fruit as rough manipulations on search can lead it to a hysterorrhesis. In such cases apply other types embryotomies (see) therefore the neck of a fruit becomes available to D. Protivopokazan D. production also at the begun and made hysterorrhesis.
Conditions for D.'s production following: true conjugate more than 6 — 6,5 cm, full or almost full disclosure of a neck of uterus, lack of a bag of waters, possibility of achievement and capture of a neck of a fruit by the surgeon.
Before operation at the woman in labor oporazhnivat a bladder and intestines. Then it is stacked in situation, usual for obstetric operations, process alcohol and iodine external genitals. The deep inhalation anesthesia is given with the purpose to cause relaxation of uterine muscles, and also to protect mentality of the patient.
Technology of operation
the Dropped-out handle of a fruit is fixed by the assistant. Operating enters the left hand into a cavity of the uterus, finds a neck of a fruit and captures her so that the thumb lay in front (behind a pubis), and index and average behind (fig. 1). The decapitation hook of Brown is entered and fixed on a neck of a fruit (see. Obstetric and gynecologic tools).
For prevention of injury of a uterus at introduction of a hook its sharikoobrazny thickening shall slide on a front surface of a hand, on a thumb, then pass to average and index fingers then the hook is strongly fixed on a neck of a fruit. Several turns of the handle of a hook of Brown make a fracture of cervical vertebras (fig. 2). The characteristic crunch is as a result heard and the head of a fruit becomes freely mobile. Fenomenov or Zibold's scissors with the rounded-off ends under control of a hand cross soft tissues of a neck of a fruit, the head separates from a trunk.
H. N. Fenomenov, V. Shtekkel, L. S. Persianinov emphasize danger of a rupture of the thinned lower segment of a uterus during the fixing of a hook and spinal fracture of a fruit. In this regard V. A. Chudovsky suggests to make a section of skin of a neck of a fruit (fig. 3) through which the decapitation hook (fig. 4) is carried out and fixed.
At a crude fruit of D. it is possible to make blunt strong scissors. At the same time the section of soft tissues, sheaves and bones of a backbone of a fruit is consistently made.
For D.'s production were offered also flexible saw with a piloprovodnik («Blond's thimble — Heydlera»), a thick guitar string etc.
The beheaded trunk easily is removed from a uterus a pandiculation for the handle (fig. 5). Extraction of the head separated from a trunk is made in several ways. More often the head is taken for a mandible for what enter the 1st or 2nd finger of the right hand into a mouth of a fruit. At the same time left hand make pressure upon a uterus through belly covers for the purpose of pressing of a head to an entrance to a basin (fig. 6). At difficulty in removal of a head (a large head, a narrow basin) sometimes it is necessary to resort to perforation of a head and a cranioclasia (see the Craniotomy).
Current of a puerperal period at women in labor is after the operation D. which is not complicated by an injury of patrimonial ways, usually smooth.
At a rough manipulation (a strong pandiculation for the handle, pushing away of a head for the purpose of capture of a neck) the rupture of a hyperinflate wall of a uterus in the lower segment is possible. Much less often injury of a uterus can be put with the end of a decapitation hook. For early identification of possible damages of patrimonial ways it is necessary to examine right after childbirth a neck of uterus and walls of a vagina by means of mirrors also manual inspection of a cavity of the uterus.
See also Fetaldestructive operations .
Bibliography: Genter G. G. Textbook of obstetrics, page 743, L., 1937; Malinovsky M. S. Operational obstetrics, page 315, M., 1974; The Multivolume guide to obstetrics and gynecology, under the editorship of L. S. Persianinov, t. 6, page 168, M., 1961.
S. N. Kopshev.