Symphysiotomy for feto-pelvic disproportion (Protocol)

Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 10/2010; 10(10):CD005299. DOI: 10.1002/14651858.CD005299.pub2
Source: PubMed


Symphysiotomy is an operation to enlarge the capacity of the mother’s pelvis by partially cutting the fibres joining the pubic bones at the front of the pelvis. Usually, when the baby is too big to pass through the pelvis, a caesarean section is performed. If caesarean section is not available, or the mother is too ill for, or refuses, caesarean section or if there is insufficient time to perform caesarean section (for example when the baby’s body has been born feet first, and the head is stuck), symphysiotomy may be performed. Local anaesthetic solution is injected to numb the area, then a small cut is made in the skin with a scalpel, and most of the fibres of the symphysis are cut. As the baby is born, the symphysis separates just enough to allow the baby through. Large observational studies have shown that symphysiotomy is extremely safe with respect to life-threatening complications, but rarely may result in pelvic instability. For this reason, and because the operation is viewed as a ‘second-class’ operation, it is seldom performed today. Health professionals fear censure should they perform a symphysiotomy which leads to complications. Proponents argue that many deaths of mothers and babies from obstructed labour in parts of the world without caesarean section facilities could be prevented if symphysiotomy was used. This review found no randomized trials evaluating symphysiotomy.

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    ABSTRACT: To compare the maternal and neonatal outcomes of symphysiotomy (SYM) and cesarean section (CS), when they were performed in women presenting with obstructed labor. This was a prospective comparative cohort study. Symphysiotomy was performed in 25 women who presented with obstructed labor. The controls were 50 women on whom CS was performed due to obstructed labor. Maternal mortality and morbidity due to postpartum hemorrhage (PPH), sepsis, genitourinary trauma, pelvic pain and gait problems were analyzed and compared between cases and controls. Neonatal mortality and morbidity due to birth asphyxia, intracranial hemorrhage, cephalohematoma and hypoxic ischemic encephalopathy were also compared following the two procedures. Maternal mortality was similar in both the cesarean section group (CSG) and symphysiotomy group (SG), but SYM has less morbidity than CS, and also preserves the uterus from scars. Transient pelvic pain was the most common maternal morbidity following SYM, whereas PPH and wound sepsis were the most common complications after CS. Neonatal mortality and morbidity were similar in both cases and controls. Lastly, SYM is a simple, low-cost and quicker procedure than CS. Symphysiotomy is an alternative management in women with obstructed labor. It has a role in low-resource settings, where CS is unaffordable, unavailable or unsafe. For the vast majority of the poor population, who may not have even have one proper meal a day, it can be of benefit to have a woman's pelvis made permanently adequate so that traditional birth attendants can conduct her subsequent labors.
    Journal of Obstetrics and Gynaecology Research 03/2011; 37(7):770-4. DOI:10.1111/j.1447-0756.2010.01431.x · 0.93 Impact Factor
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    Article: Indication.
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