Symphysiotomy for feto-pelvic disproportion

Hofmeyr, G Justus; Shweni, P Mike

doi:10.1002/14651858.cd005299.pub2

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…It was 6% in another series of 100 CS in rural Tanzania. We could not find any published reports of maternal mortality directly related to symphysiotomy in the antibiotic era to date 2 . Both ventouse and forceps can be applied after SYM to achieve a vaginal delivery if spontaneous delivery does not occur.…”

Section: Discussionmentioning

confidence: 91%

“…In July 2003, maternal health specialists from around the world gathered in Bellagio, Italy, to develop a list of proven and promising technologies appropriate for low‐resource settings to reduce maternal mortality 9 . Symphysiotomy is advocated as one such simple underused and alternative technology that can save the lives of women with obstructed labor and its sequelae, such as uterine rupture, sepsis, and neonatal mortality and morbidity, even if the women live far from a health centre 2,10,11 …”

Section: Resultsmentioning

confidence: 99%

“…Therefore, the non‐availability of specialized doctors in rural areas of our country can be bypassed by training every midwife or graduate doctor how to perform this simple procedure, thus saving the lives of many poor mothers. Moreover, it is a quick procedure, requiring few instruments 2 . Its main advantage is that it does not carry the risk of scarred uterus in subsequent pregnancies, particularly when the woman may not have ready access to CS in the future.…”

Section: Resultsmentioning

confidence: 99%

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Symphysiotomy: Is it obsolete?

Basak

Kanungo

Majhi

2011

J of Obstet and Gynaecol

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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.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Symphysiotomy: Is it obsolete?

Basak

Kanungo

Majhi

2011

J of Obstet and Gynaecol

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“…In the absence of randomised data, a Cochrane review 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 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.…”

Section: Discussionmentioning

confidence: 99%

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

Wilson

Truchanowicz

Elmoghazy

et al. 2016

BJOG

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Background Obstructed labour is a major cause of maternal mortality. Caesarean section can be associated with risks, particularly in low-and middle-income countries, where it is not always readily available. Symphysiotomy can be an alternative treatment for obstructed labour and requires fewer resources. However, there is uncertainty about the safety and effectiveness of this procedure.Objectives To compare symphysiotomy and caesarean section for obstructed labour.Search strategy MEDLINE, EMBASE, Cochrane library, CINAHL, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction.Selection criteria Studies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes.Data collection and analysis Quality of the included studies was assessed using the STROBE checklist and the Newcastle Ottawa scale. Relative risks (RR) were pooled using the random effects model. Heterogeneity was assessed using I 2 tests.Main results Seven studies (n = 1266 women), all of which were set in low-and middle-income countries (as per the World Bank definition) and compared symphysiotomy and caesarean section were identified. Meta-analyses showed no significant difference in maternal (RR 0.48, 95% CI 0.13-1.76; P = 0.27) or perinatal (RR 1.12, 95% CI 0.64-1.96; P = 0.69) mortality with symphysiotomy when compared with caesarean section. There was a reduction in infection (RR 0.30, 95% CI 0.14-0.62) but an increase in fistulae (RR 4.19,) and stress incontinence with symphysiotomy (RR 10.04, 95% CI 3.23-31.21).Conclusion There was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section.Keywords Caesarean section, low-and middle-income countries, obstructed labour, symphysiotomy.Tweetable abstract Symphysiotomy could be an alternative to caesarean section when resources are limited.

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“…In the absence of randomised evidence, our review provides the best evidence and it shows that symphysiotomy may not be more harmful than caesarean section. We believe that symphysiotomy should be considered as an option, especially where effective, safe and timely access to caesarean section is limited.…”

mentioning

confidence: 94%

Author's reply re: Symphysiotomy for obstructed labour: a systematic review and meta‐analysis

Wilson

2017

BJOG

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Symphysiotomy for feto-pelvic disproportion

Cited by 7 publications

References 26 publications

Symphysiotomy: Is it obsolete?

Symphysiotomy: Is it obsolete?

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

Author's reply re: Symphysiotomy for obstructed labour: a systematic review and meta‐analysis

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