Decapitation (or decapitation, is an obstetrical operation)

DECAPITATIO, or decapitation, is an obstetrical operation representing a variety of embryotomy, which consists in the separation of the fetal head from the torso. It is used in neglected transverse lies when version is contraindicated, as it can easily lead to uterine rupture. With the expansion of the network of women's consultations, the hospitalization of pathological cases, and the improvement of obstetric care in cities, decapitation is beginning to pass into the realm of the past. In rural practice, neglected transverse lies are still quite common. Decapitation is most often performed on a dead fetus. The operation can be performed if the obstetrician succeeds in grasping the fetal neck with their fingers. Typically, the operation is performed using Braun's hook. After pulling down the prolapsed arm ad maximum, under the guidance of the hand (the hand corresponding to the head is introduced, considering the obstetrician's side), the hook is guided along the anterior surface of the neck and hooked behind the latter. After this, the obstetrician rotates the hook around its longitudinal axis in such a way that the button of the hook faces the torso. A fracture of the cervical spine occurs. Having separated the vertebrae, the soft tissues are torn with the hook or severed with scissors. The torso is extracted by the prolapsed arm; the head is extracted either by ordinary manual maneuvers, inserting a finger into the mouth, or by resorting to perforation followed by cranioclasis. Many obstetricians consider the dislocation of the vertebrae using Braun's hook dangerous, preferring after bringing down the neck to dissect the tissues (mainly the ligaments) of the spine with sturdy Siebold's scissors. Many do not use Braun's hook at all and perform the entire decapitation with scissors alone. To simplify the operation, many different instruments have been proposed (Gigli wire saw, Zweifel's tracheolirector, and others), which have not gained widespread use in practice. Lit.: Bokanov F., On the Technique of Decapitation, Gynecology and Obstetrics, 1927, no. 4; Fenomenov N., Operative Obstetrics, p. 292, Kazan, 1897; Franz K., Klin. Erfahrungen über die Dekapitation mit dem Hakenmesser, Arch. f. Gyn., B. CXIX, 1923; Sztehlo S., Ein neues Instrument zur Dekapitation d. Frucht, Zentralbl. f. Gyn., 1929, no. 4; Winter G., Die operative Geburtshilfe (Biologie u. Pathologie des Weibes, hrsg. von J. Halban und L. Seitz, B. VIII, T. 2, B.-W., 1927).