Subcutaneous Symphysiotomy — Time for a Reappraisal?

Abstract

A series of 138 patients in whom symphysiotomy had been performed is presented. The vicissitudes of this operation are reviewed and an evaluation has been attempted of its role in the management of moderate disproportion. Early and late complications were few and rarely serious if recommended guidelines were adhered to.In the 200 years since symphysiotomy was repeat Caesarean sections. The next stage in first performed it has provoked considerable the operation's rehabilitation occurred about emotion amongst obstetricians. In our own 12 years ago when doctors working in Africa time, uncritical advocacy and uninformed con-began to realise the dangers connected with demnation have combhed to so bemuse the delivery following lower segment Caesarean average obstetrician that if he ever considers section. A maternal mortality rate of the operation at all it is with indifference. 2.37% was reported from East Africa (Mit-The operation's zenith occurred at the turn of the century. Unfortunately it was undoubtedly misused at the time because of the great dangers of Caesarean section. But even at the height of its popularity it was not used very much in Britain and North America. With the increasing safety and popularity of Caesarean section as the mainstay of treatment in cephalopelvic disproportion, symphysiotomy fell into disrepute. However, in 1920 the operation was resurrected by Zarate of Argentina (1955). He improved the technique and delineated the indications for its performance. He had a number of followers in Spain and South America. After the Second World War the operation was taken up again in Eire (Spin, 1949). In these predominantly Roman Catholic countries where sterilization and contraception were theologically suspect and large families were common, symphysiotomy was of special use in avoiding multiple 1. Obstettic and Gynaecological Surgeon.

Symphysiotomy for obstructed labour: a systematic review and meta‐analysis

“…In countries where mortality from caesarean section is low, such as high‐income countries with current standards of obstetric care, symphysiotomy may be obsolete . Even at the peak of the popularity of symphysiotomy, it was not widely used in Britain and North America …”

“…25 Even at the peak of the popularity of symphysiotomy, it was not widely used in Britain and North America. 26 In the absence of randomised data, a Cochrane review 27 concluded that research was needed to provide robust evidence on the effectiveness and safety of symphysiotomy compared with caesarean section in clinical situations in which the risks and benefits are uncertain. One systematic review 12 of retrospective case series concluded that with training, symphysiotomy poses no greater risks and compares favourably with caesarean section, in terms of risk for the mother's life.…”