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A Method of Delivery for Hydrocephalus Associated With Breech Presentation
A METHOD OF DELIVERY FOR HYDROCEPHALUS ASSOCIATED WITH BREECH PRESENTATION D.
N.
DANFORTH, M.D., CHICAGO, ILL.
(l!'rom the Department of Obstetrics and Gynecology, Wesley Memor·ial Hospital, and the Northwestern University Medical School)
T
HE method to be described was suggested by a description in Stander's Obstetrics/ and differs from this only in minute detail. It is therefore presented not because of originality, but rather because its extreme simplicity and safety warrant for the procedure a more general acceptance than it has received. A recent case is the impetus for this report.
Fig. 1.
Method of Delivery.- If the case is one of fr·ank breech, the breech is allowed to advance and is delivered according to accepted procedure, with one exception : since the labor is to end by stillbirth, it is permissible to spare the patient the necessity of delivering the breech by voluntary effort. This may be accomplished, when the breech approaches the perineum, by making traction in the groin with a blunt hook. Delivery of the breech and of the shoulders is then completed as under ordinary circumstances. No attempt is made to cause the head to engage more deeply. A Jackson retractor is placed anteriorly,. and the highest spinous processes which one can visualize are palpated. An incision is made in the midline over two of these processes, which ordinarily are those of the lower cervical or upper thoracic spine. The skin edges are retracted by Allis forceps, and a laminectomy performed over these two segments. (This is readily accomplished in the fetus by incision through 694
Volume 54 Number 4
HYDROCEPHALUS DELIVERY
695
the laminae with a scalpel, and removal of the fragment with a small rongeur.) The tip of a uterine dressing forceps-which is considered as preferable to the catheter as mentioned in the original description-is introduced into the opening in the spinal canal. and forced gently but firmly upward into· the cranial cavity. It is rotated to enlarge the canal, and the blades are separated slightly. By making pressure upon the head from above, cerebrospinal fluid is caused to issue from the laminectomy wound. This is continued until either the flow of fluid stops, or the collapsed head advances sufficiently that it can be delivered. The dressing forceps is now withdrawn, and the head delivered by the Mauriceau maneuver. The procedure is simplicity itself. Since it is done under direct vision without possibility of injury to the maternal soft parts by bone spicules, it is considered as preferable to the more popular approach with the customary perforator behind the ear or through the lamboidal suture.
Reference l. Stander, Henrieus J.:
Obstetrics, New York, 1945, D. Appleton-Century Co., pp. 926, 1119.
N.
DANFORTH, M.D., CHICAGO, ILL.
(l!'rom the Department of Obstetrics and Gynecology, Wesley Memor·ial Hospital, and the Northwestern University Medical School)
T
HE method to be described was suggested by a description in Stander's Obstetrics/ and differs from this only in minute detail. It is therefore presented not because of originality, but rather because its extreme simplicity and safety warrant for the procedure a more general acceptance than it has received. A recent case is the impetus for this report.
Fig. 1.
Method of Delivery.- If the case is one of fr·ank breech, the breech is allowed to advance and is delivered according to accepted procedure, with one exception : since the labor is to end by stillbirth, it is permissible to spare the patient the necessity of delivering the breech by voluntary effort. This may be accomplished, when the breech approaches the perineum, by making traction in the groin with a blunt hook. Delivery of the breech and of the shoulders is then completed as under ordinary circumstances. No attempt is made to cause the head to engage more deeply. A Jackson retractor is placed anteriorly,. and the highest spinous processes which one can visualize are palpated. An incision is made in the midline over two of these processes, which ordinarily are those of the lower cervical or upper thoracic spine. The skin edges are retracted by Allis forceps, and a laminectomy performed over these two segments. (This is readily accomplished in the fetus by incision through 694
Volume 54 Number 4
HYDROCEPHALUS DELIVERY
695
the laminae with a scalpel, and removal of the fragment with a small rongeur.) The tip of a uterine dressing forceps-which is considered as preferable to the catheter as mentioned in the original description-is introduced into the opening in the spinal canal. and forced gently but firmly upward into· the cranial cavity. It is rotated to enlarge the canal, and the blades are separated slightly. By making pressure upon the head from above, cerebrospinal fluid is caused to issue from the laminectomy wound. This is continued until either the flow of fluid stops, or the collapsed head advances sufficiently that it can be delivered. The dressing forceps is now withdrawn, and the head delivered by the Mauriceau maneuver. The procedure is simplicity itself. Since it is done under direct vision without possibility of injury to the maternal soft parts by bone spicules, it is considered as preferable to the more popular approach with the customary perforator behind the ear or through the lamboidal suture.
Reference l. Stander, Henrieus J.:
Obstetrics, New York, 1945, D. Appleton-Century Co., pp. 926, 1119.