Value of Symphysiotomy in Obstructed Labour Management and Follow-Up of 31 Cases

Abstract

Experience of 32 cases of symphysiotomy carried out in Mozambique and in Botswana is reviewed. Of all cases only 1 was lost to follow-up. The observation period varied from 7 days to 6 months. Among 31 cases examined at discharge or on return for check-up few complications occurred. Vaginal laceration occurred in 3 cases, haematuria in 1 case and wound infection in 1 case. In 2 cases there was significant postoperative pain causing gait problems, but in no case were there significant problems with pain at discharge or at follow-up. It is concluded that the intervention is seldom complicated by severe sequelae, provided strict adherence to given indications is respected. In rural areas in the third world symphysiotomy is a life-saving and simple surgical intervention, which should be regarded as an adjunct measure in some cases with a moderately contracted pelvic outlet incompatible with normal vaginal delivery.

Symphysiotomy in Zimbabwe; Postoperative Outcome, Width of the Symphysis Joint, and Knowledge, Attitudes and Practice among Doctors and Midwives

“…The results from the present study and previous follow-up studies indicate that symphysiotomy confers an acceptable level of complaints in the long run [10], [16], [32], [36], [38]. Lasbrey assessed pain in the symphysis pubis, groin, hip, thigh, sacro-iliac joint and stress incontinence, mostly associated with physical activity, and found that these problems were small and did not interfere with day-to-day activities [36].…”

“…Infertility after symphysiotomy was not addressed in the present study, and the woman who reported incontinence was apparently subject to an incorrect judgement of the degree of cephalopelvic disproportion. Pain or tenderness over the symphysis pubis when walking long distances was observed in this study, but not reported nor mentioned as a parameter in previous follow-up studies [4], [10], [13], [32]–[38]. Dyspareunia was registered in 17,2% (CS group) and 29,4% (S group) of the women in this study, unfortunately women with normal vaginal deliveries were not asked about this.…”

“…According to the literature symphysiotomy is associated with immediate post-operative pain and discomfort [4], [10], [12], [13], [16]–[18], [32]–[38], and it is a painful procedure when insufficient local anaesthesia is given. All women will experience pain at the moment of delivery, and separating the different origins of pain in labour might be difficult, also because an episiotomy and mostly a vacuum extraction is part of the symphysiotomy procedure.…”

Minimally invasive surgery for obstructed labour: a review of symphysiotomy during the twentieth century (including 5000 cases)

“…Not stated Sabriá Ayiné (1949) 55 Spain 68 Botswana Not stated 25 0 0 Mola (1995) 69 Papua palpable per abdomen, a trial of vacuum extraction was done before proceeding to symphysiotomy. However, the trial of vacuum extraction was omitted in cases with fetal distress 39 .…”

“…Time interval Women Symphyseal width (cm) n Mean Corrected Mean (Range) Kehrer (1913) 31 33 days 9 68 25 0 0 0 --Mola (1995) 69 62 -0 ---Pape (1999) 7 27 the symphyseal joint in a woman who had undergone symphysiotomy showed ''collagenous connective tissue containing a few vascular channels'' 76 .…”