The Simpson's perforator is held closed in the operator's hand while its tip is protected by the fingers of the other hand which guide it through the birth canal up to the site of perforation and applied perpendicular to it. The tip is forced into the site of perforation up to shoulders of the perforator which is then opened to produce a linear incision in the skull bones. The perforator is closed, rotated 90 o and re-opened again thus producing a cruciate incision. The resultant hole is enlarged by the closed perforator which is pushed to allow drainage of the CSF and brain matter. The closed perforator is withdrawn while its tip is protected by the fingers.
Spontaneous delivery can occur after reduction of the size of hydrocephalus.
Two volsella or Willet's scalp forceps may be applied for traction. Forceps can be applied if there is no disproportion. The after - coming head is delivered as in breech delivery. The birth canal should be explored after delivery. Double -headed monsters.