TV4101 - MSAT - SP1 - Foetotomy

What is C and E?

C - Krey hook with attached chain

E - Obstetric chain handle

What is…

A?

B?

D?

E?

G?

A - Utrecht Foetotome

B - Threader for foetotome

D - Wire saw handles

E - Wire passer/introducer

G - Palm knife

Indications for a Foetotomy Include?

Case selection aspect?

Percutaneous “classical” foetotomy – cranial presentation

Cuts include?

6 cuts, 7 pieces

1. Removal of head and neck (1 cut, 1 piece)

2. Removal of both forelimbs (2 cuts, 2 pieces)

3. Foetal Trunk (Thoracic and Abdominal → 2 cuts and 2 pieces)

4. Bisection of pelvis (1 cut, 2 pieces)

Percutaneous modified foetotomy – cranial presentation

Cuts include?

4 cuts, 5 pieces

1. Removal of head and a forelimb (1 cut, 1 pc)

   a. Can eviscerate thorax and abdomen

   b. Can also cut foetal ribs and collapse thorax

2. Transection of foetus trunk (Can cut along thorax and abdomen OR just cut in one place: depends on how much you can access

3. Bisection of pelvis

Percutaneoues Foetotomy - Classic and Cranial

First cut

Describe what we apply to the foetus?

Where does the wire go?

Where is the foetotome positioned?

Apply Obstetrical chains to each forelimb

Wire to go around the head and under the neck as high up as we can - don’t want to leave a stump

?

Percutaneoues Foetotomy - Classic and Cranial

Second cut (Head and neck already removed)

Describe what we apply to the foetus?

Where does the wire go?

Where is the foetotome positioned?

Obstetrical chains to each forelimb

Wire placement

1. Place the wire between the two claws and advance the foetotome head dorsal and caudal to the scapula

2. Once head is positioned → wire can move medially off claws and lie within the axillary region

Subcutaneous foetotomy

Indications?

• Emphysematous / oedematous foetus in cranial/caudal where passing instruments is impossible/dangerous (Tightly impacted)

• An emphysematous or oedematous foetus with limb or head displaced (Removal of extended limb may allow more room to correct displacement)

• A tightly impacted emphysematous foetus in caudal presentation with bilateral hip flexion

• Dead lamb/kid with limb retention – removal of one limb using a subcutaneous method can often allow the foetus to be delivered

Subcutaneous foetotomy

What are these?

Foetotome types - which is which?

Bisection of pelvis - Krey Hook position?

Around the spinal column - but have it diagonal