Brachiotomy

Brachiotomy (from Greek brachion-hand and tome-cutting), removal of a prolapsed hand (exarticulation at the shoulder joint) during fetal decapitation. As a rule, brachiotomy is not recommended, since with the help of the prolapsed hand, by pulling it, the operator can more easily bring the corresponding shoulder and neck to the pelvic outlet and thereby facilitate the performance of decapitation. Some consider brachiotomy indicated when the prolapsed hand in a neglected transverse position is so swollen that it hinders the introduction of the obstetrician's hand into the vagina. Usually in this case, an episiotomy is preferred (cases of exarticulation of the hand in a living child, mistakenly taken for dead, have been described). In the so-called "zemsky method" of delivery, in neglected transverse position with prolapse of the hand (Rakashchev's method), the removal of the hand is done as a preliminary step for subsequent evisceration (operation for removal of internal organs of a deceased fetus) and spondylotomy (division of the spine).