Managing Complications in Pregnancy and Childbirth: - IAWG

P-58 Craniotomy and craniocentesis• Grasp the edges of the skull with several heavy-toothed forceps(e.g. Kocher’s) and apply traction in the axis of the birth canal (FigP-29).FIGURE P-29Extraction by scalp traction• As the head descends, pressure from the bony pelvis will causethe skull to collapse, decreasing the cranial diameter.• If the head is not delivered easily, perform caesarean section (pageP-43).• After delivery, examine the woman carefully and repair any tears tothe cervix (page P-81) or vagina (page P-83), or repair episiotomy(page P-73).• Leave a self-retaining catheter in place until it is confirmed thatthere is no bladder injury.• Ensure adequate fluid intake and urinary output.BREECH PRESENTATION WITH ENTRAPPED HEAD• Make an incision through the skin at the base of the neck.• Insert a craniotome (or large pointed scissors or a heavy scalpel)through the incision and tunnel subcutaneously to reach theocciput.• Perforate the occiput and open the gap as widely as possible.• Apply traction on the trunk to collapse the skull as the headdescends.