Managing Complications in Pregnancy and Childbirth: - IAWG

Craniotomy and craniocentesisP-59CRANIOCENTESIS (skull puncture)• Review for indications.• Review general care principles (page C-17) and apply antisepticsolution to the vagina (page C-22).• Make a large episiotomy, if required (page P-71).FULLY DILATED CERVIX• Pass a large-bore spinal needle through the dilated cervix andthrough the sagittal suture line or fontanelles of the fetal skull(Fig P-30).• Aspirate the cerebrospinal fluid until the fetal skull has collapsedand allow normal delivery to proceed.FIGURE P-30Craniocentesis with a dilated cervixCLOSED CERVIX• Palpate for location of fetal head.• Apply antiseptic solution to the suprapubic skin (page C-22).• Pass a large-bore spinal needle through the abdominal and uterinewalls and through the hydrocephalic skull.• Aspirate the cerebrospinal fluid until the fetal skull has collapsedand allow normal delivery to proceed.