Symphysiotomy

Jump to navigation Jump to search

WikiDoc Resources for Symphysiotomy

Articles

Most recent articles on Symphysiotomy

Most cited articles on Symphysiotomy

Review articles on Symphysiotomy

Articles on Symphysiotomy in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Symphysiotomy

Images of Symphysiotomy

Photos of Symphysiotomy

Podcasts & MP3s on Symphysiotomy

Videos on Symphysiotomy

Evidence Based Medicine

Cochrane Collaboration on Symphysiotomy

Bandolier on Symphysiotomy

TRIP on Symphysiotomy

Clinical Trials

Ongoing Trials on Symphysiotomy at Clinical Trials.gov

Trial results on Symphysiotomy

Clinical Trials on Symphysiotomy at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Symphysiotomy

NICE Guidance on Symphysiotomy

NHS PRODIGY Guidance

FDA on Symphysiotomy

CDC on Symphysiotomy

Books

Books on Symphysiotomy

News

Symphysiotomy in the news

Be alerted to news on Symphysiotomy

News trends on Symphysiotomy

Commentary

Blogs on Symphysiotomy

Definitions

Definitions of Symphysiotomy

Patient Resources / Community

Patient resources on Symphysiotomy

Discussion groups on Symphysiotomy

Patient Handouts on Symphysiotomy

Directions to Hospitals Treating Symphysiotomy

Risk calculators and risk factors for Symphysiotomy

Healthcare Provider Resources

Symptoms of Symphysiotomy

Causes & Risk Factors for Symphysiotomy

Diagnostic studies for Symphysiotomy

Treatment of Symphysiotomy

Continuing Medical Education (CME)

CME Programs on Symphysiotomy

International

Symphysiotomy en Espanol

Symphysiotomy en Francais

Business

Symphysiotomy in the Marketplace

Patents on Symphysiotomy

Experimental / Informatics

List of terms related to Symphysiotomy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Symphysiotomy is a surgical procedure in which the cartilage of the symphysis pubis is divided to widen the pelvis allowing childbirth when there is a mechanical problem.

Introduction

Symphysiotomy was also advocated in 1597 by Severin Pineau after his description of a diastasis of the pubis on a hanged pregnant woman [1]. Thus symphysiotomies became a routine surgical procedure for women experiencing an obstructed labour. In the late 19th century [2] after the risk of maternal death after caesarean section decreased due to improvement in techniques, hygiene and clinical practice the symphysiotomy was rarely used.

Indications for the procedure

The most common indications are a trapped head of a breech baby, shoulder dystocia which does not resolve with routine manoeuvres and obstructed labour at full cervical dilation when there is no option of a caesarean section. Currently the procedure is rarely performed in developed countries, but is still routine in developing countries where caesarean section is not always an option.[3]

Surgical application

Symphysiotomy results in a temporary increase in pelvic diameter (up to 2 cm) by surgically dividing the ligaments of the symphysis under local anaesthesia. This procedure should be carried out only in combination with vacuum extraction. Symphysiotomy in combination with vacuum extraction can be a life-saving procedure in areas of the world where caesarean section is not feasible or immediately available. Symphysiotomy leaves no uterine scar and the risk of ruptured uterus in any future labour is not increased.[citation needed]

The procedure is not without risk, including urethral and bladder injury, infection, pain and long-term walking difficulty. Symphysiotomy should, therefore, be carried out only when there is no safe alternative.[citation needed] It is advised that this procedure should not be repeated due to the risk of the woman developing long term walking problems and continued pain.[citation needed]

Abduction of the thighs more than 45 degrees from the midline may cause tearing of the urethra and bladder.

  1. Give appropriate analgesic drugs.
  2. Apply elastic strapping across the front of the pelvis from one iliac crest to the other to stabilize the symphysis and reduce pain.
  3. Leave the catheter in the bladder for a minimum of 5 days.
  4. Encourage the woman to drink plenty of fluids to ensure a good urinary output.
  5. Encourage bed rest for 7 days after discharge from hospital.
  6. Encourage the woman to begin to walk with assistance when she is ready to do so.

If long-term walking difficulties and pain are reported (occur in 2% of cases), treat with physical therapy. [4]

Ireland and Symphysiotomy

Irish women who unknowingly and without consent underwent symphysiotomies during childbirth between the 1950s and 1980s say they were left them with severe side effects, including extreme pain, incontinence and depression. Irish obstetricians sought to establish this operation as an alternative to Caesarean sections because it was thought that women subjected to repeated Caesareans 'might be tempted to use contraception'.[5]

References

  1. Dumont M: La longue et laborieuse naissance de la symphysÄotomie ou de SÄverin Pineau ê Jean-RenÄ Sigault. J Gynecol Obstet Biol Reprod 1989;18:11-21
  2. Bergstrsm S, Lublin H, Molin A: Value of Symphysiotomy in Obstructed Labour Management and Follow-up of 31 Cases. Gynecol Obstet Invest 1994;38:31-35
  3. Verkuyl DA (2007). "Think globally act locally: the case for symphysiotomy". PLoS Med. 4 (3): e71. doi:10.1371/journal.pmed.0040071. PMID 17388656.
  4. "Managing Complications in Pregnancy and Childbirth (MCPC)". Retrieved 2007-11-24.
  5. "Ireland orders inquiry into "barbaric" obstetric practices -- Payne 322 (7296): 1200 -- BMJ". Retrieved 2007-11-24.

Template:Obstetrical procedures


Template:WH Template:WS