Managing Complications in Pregnancy and Childbirth: - IAWG

CRANIOTOMY AND CRANIOCENTESIS P-57In certain cases of obstructed labour with fetal death, reduction in thesize of the fetal head by craniotomy makes vaginal delivery possibleand avoids the risks associated with caesarean delivery. Craniocentesiscan be used to reduce the size of a hydrocephalic head to make vaginaldelivery possible.• Provide emotional support and encouragement. If necessary, givediazepam IV slowly or use a pudendal block (page P-3).CRANIOTOMY (skull perforation)• Review for indications.• Review general care principles (page C-17) and apply antisepticsolution to the vagina (page C-22).• Perform an episiotomy, if required (page P-71).CEPHALIC PRESENTATION• Make a cruciate (cross-shaped) incision on the scalp (Fig P-28).FIGURE P-28Cruciate incision on scalp• Open the cranial vault at the lowest and most central bony pointwith a craniotome (or large pointed scissors or a heavy scalpel). Inface presentation, perforate the orbits.• Insert the craniotome into the fetal cranium and fragment theintracranial contents.