New application of the myomectomy screw

Abstract

Background: Healthcare is inadequately funded in developing countries leading sometimes  to the unavailability of the best instrument for a procedure . Even when such equipments are available ,the poor maintenance culture  often renders them unusable when needed. Doctors are therefore forced to improvise in some cases to get the job done.
Aim: To report a case in which a myomectomy screw was  improvised for the delivery of   a dead fetus because the ventouse in the labour ward was ineffective, the blades of the forceps available did not lock, and there was no craniotomy forceps.
Case Report: A 28- year-old primigravida presented after three days labour in a maternity. Examination revealed twin gestation(cephalic /breech),  a fully  dilated cervix and fetal distress. The babies died before caesarean section could be done. The first twin was delivered using an improvised myomectomy screw because the preferred instruments were either non effective or non available. The second twin was delivered by breech extraction. The puerperium was uneventful.
Conclusion: A new application of the  myomectomy screw has been described. The myomectomy screw  should be part of the armamentarium of every  labour ward in the developing countries. It has the advantages of low cost, low maintenance and easy application. In addition the  deformation of the fetus is minimal.

Keywords:  Multiple pregnancy, Intrauterine death, Delayed second stage, Myomectomy screw