Embryotomy

EMBRYOTOMY, embryotomia, embryoulcia (from the Greek embryon - embryo, fetus, and tome - section), fetal mutilation, an obstetric operation involving the dissection of the fetus to extract it in parts through the natural birth canal. In a broad sense, this term also includes the operation of cranial perforation followed by cranioclasis (see Craniotomy); however, at present, embryotomy is understood mainly as the decapitation of the fetus in a neglected transverse lie (see Decapitation). With proper obstetric care, such an indication should occur extremely rarely, since any transverse lie of the fetus must be diagnosed in a timely manner during pregnancy or at the onset of labor, when, with intact membranes, the operation of choice is version of the fetus by external or internal maneuvers. Some time after the rupture of the membranes, when fetal mobility decreases to such an extent that version is no longer possible or becomes dangerous for the mother (uterine rupture), the obstetrician faces two paths: Cesarean section—in the case of a living fetus and favorable conditions—or embryotomy. Typical embryotomy is usually performed with Braun's decapitation (sharp) hook and Siebold's scissors (other instruments have also been proposed, see Obstetric instruments). - Operation technique: the operator's hand is inserted into the vagina, and two fingers grasp the neck of the fetus from behind (see figure). If there is a prolapsed arm, pulling on the arm greatly facilitates this moment of the operation.

With the other hand, the operator inserts the hook into the vagina and, under the guidance of the internal hand, also grasps the neck of the fetus. After this, the hook is pulled so that it penetrates between the cervical vertebrae, and rotational movements are then made to the right and left, which achieves dislocation of the spine. The hook is now pulled harder, thereby pulling down the soft tissues of the neck so that they can be more conveniently cut with scissors. This concludes the decapitation. After this, the trunk of the fetus is extracted by pulling on the arm, and then the fetal head is removed by hand or with bone forceps. In cases where the fetal neck is out of reach for the operator's hand because the chest or side is presenting, it is necessary to first dissect the chest or abdominal wall and preliminarily remove the fetal viscera (evisceratio), and then cut the soft tissues and spine of the fetus in its most accessible section (spondylotomy, rachiotomy). The fetus dissected in this manner is extracted manually—first the lower part of the trunk is extracted, then the upper. It must be said, however, that when it is impossible to perform embryotomy in a strictly typical manner, the operator is allowed to proceed in accordance with the specific features of the given case.