Fetotomy

Under Fetotomie is meant an obstetric operation in which the to-bearing fruit ( fetus is divided) so that it through the birth canal fits. In addition to the fragmentation of the fruit, there is also the rarer variant, in which only parts of the interior of the fetus are removed in order to reduce its size.

Human medicine

In human medicine , where the term embryotomy is mostly used for this, this procedure has almost completely been replaced by the caesarean section . In the past, however, if a child could not be born using other obstetric methods, it was sometimes the last and only way to sustain a mother's life. Nowadays, an embryotomy might only be indicated if the child's head has already been born and neither trunk nor limbs can be developed.

Veterinary medicine

In veterinary medicine , the fetotomy is mainly used in horses and cattle . These animals are large enough to allow a fetotomy through the birth canal. The fetotomy in domestic mammals has been known as a method of obstetrics in difficult births since the Greeks and Romans. Fruits that had died in the womb were broken up relatively unsystematically with the help of finger knives. Only with the development of the tubular fetotome by Thygesen (1921/22), its modification by Richard Götze (1928) and the introduction of epidural anesthesia by Pape and Pitzschk (1925) in the first half of the 20th century, the fetotomy became a common veterinary procedure . With the introduction of sulfonamides and antibiosis around 1950, however, there were new possibilities for infection prophylaxis in surgical interventions, so that the fetotomy in horses and cattle was increasingly replaced by caesarean section (caesarean section, caesarean section) in many indications. Nevertheless, there are still indications today in which the fetotomy is the method of choice over the caesarean section .

Indications for a fetotomy in cattle and horses are:

• a too narrow bony birth canal (juvenile dam, congenital or acquired pelvic abnormalities)
• a soft birth canal that is too narrow (due to insufficient widening or a delayed birth)
• too big a fruit
• Postures or positions of the fetus that cannot be corrected by the obstetrician and that prevent it from moving out
• Malformations of the fruit ( Schistosoma reflexum , torticollis )
• an inflation of the fruit, which becomes too big for the passage through the birth canal
• a fruit stuck in the birth canal that cannot be further developed

Complications from a fetotomy can include injuries to the uterus or the soft birth canal. These can arise, on the one hand, from the instruments inserted into the birth canal and the necessary manipulations by the obstetrician. On the other hand, depending on the incision, sharp-edged bone tips can arise when the fetus is dissected, which can also cause injuries in the soft birth canal when pulled out. If the procedure takes too long, the manipulation can lead to increasing swelling of the birth canal, which makes further work more difficult. In the case of fetuses that have died a long time in the womb and are infected with bacteria, there is a risk of infection for the mother and obstetrician due to the dissection.

Performing the fetotomy

In veterinary medicine, the fetotomy is performed with the help of a fetotome (also called an embryotome). It is a metal veterinary instrument that consists of either two parallel tubes (Thygesen's fetotome modified by Götze) or a single tube with a rounded head at the end with two outlets for the saw wire (Neubarth fetotome and Benesch). A wire saw is passed through the tube (s) and forms a loop at the end of the fetotome that is placed around the part of the fetus to be weaned. At the other end of the wire saw, two handles are attached to which the saw can be operated.

The fetotomy is performed with the mother standing or lying down. The sensation of pain and the abdominal pressure are switched off by an epidural anesthesia , the labor by the administration of a uterine relaxant .

A fetotomy is always performed on the dead fetus; If the fruit is still alive but cannot survive after birth, an intrauterine euthanasia is carried out before the start of the fetotomy.

In a total fetotomy , the fetus is divided into several pieces that can be developed individually through the birth canal. In the case of a partial fetotomy, on the other hand, only individual parts of the body that naturally hinder the development of the fruit are separated with the help of the fetotome, so that the remaining fruit can be extracted through the birth canal.

Web links

• Historical text on the subject of embryotomy in human medicine

Individual evidence

1. ↑ Indications for embryotomy ( Memento of March 2, 2015 in the Internet Archive ), Obstetrical and Gynecological Collection at the Clinic and Polyclinic for Gynecology and Obstetrics at the Ernst-Moritz-Arndt University of Greifswald
2. ↑ S. Fey: The artificial dismemberment and extraction of the most serious irregular births in agricultural larger domestic mammals. W. Wallis, Konstanz 1823, p. 28ff digitized
3. ↑ R. Götze, J. Ließ: The new modification of the wire saw embryotome . In: German veterinary weekly. 1928
4. ↑ J. Pape, C. Pitschek: Experiments on extradural anesthesia in horses. In: Archives for Scientific and Practical Veterinary Medicine . Berlin 1926, pp. 558-571.
5. ↑ E. Grunert: Fetotomy in cattle and horses . In: J. Richter, R. Götze: Tiergeburtshilfe . Edited by E. Grunert and K. Arbeiter, 4th, completely revised edition, Paul Parey Verlag, Berlin, p. 301
6. ↑ E. Grunert: Fetotomy in cattle and horses . In: J. Richter, R. Götze: Tiergeburtshilfe . Edited by E. Grunert and K. Arbeiter, 4th, completely revised edition, Paul Parey Verlag, Berlin, p. 301
7. ↑ J. Aurich, S. Brückner, M. Scheibenpflug: Legal issues in reproductive medicine in horses. In: J.-E. Aurich: reproductive medicine in horses: gynecology - andrology - obstetrics . Georg Thieme Verlag, Stuttgart 2008, p. 360f
8. ↑ R. Götze, J. Ließ: The new modification of the wire saw embryotome . In: German veterinary weekly. , 1928
9. ↑ J.-E. Aurich: Obstetrics. In: J.-E. Aurich: reproductive medicine in horses: gynecology - andrology - obstetrics . Georg Thieme Verlag, Stuttgart 2008, p. 177ff

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