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At least 19 recordsLinked to original sources
PubMed1987

Symphysiotomy as an alternative to cesarean section.

The author compares the value of symphysiotomy to cesarean section in the management of cephalopelvic disproportion. He outlines the history of the procedure and reviews the literature on the subject. He then presents results of 54 symphysiotomies performed from 1976 to 1983 in two rural hospitals in the southwestern highlands of Tanzania, together with the outcome of subsequent labor in 25 other women with a history of previous symphysiotomy. The risk of maternal mortality after symphysiotomy is lower than after cesarean section when performed for cephalopelvic disproportion. Although different in nature, maternal morbidity after both operations is equally common. In contrast with findings reported in the literature, a history of previous symphysiotomy still constitutes a high obstetrical risk. The author concludes that symphysiotomy has a place in the management of cephalopelvic disproportion.

Africa↗
PubMedDate not supplied

[What about partial subcutaneous symphysiotomy or Zarate's operation? Review of the literature].

This study is a review of the literature on Zarate's partial subcutaneous symphysiotomy. Unfortunately, this operation is now forgotten since many obstetricians in western countries and even those of developing countries feel that symphysiotomy is an obsolete obstetric procedure. Partial subcutaneous symphysiotomy is an operation intended to widen the maternal pelvis in order to enable vaginal delivery in the presence of moderate feto-pelvic disproportion. The procedure, which requires only a urinary catheter, a scalpel and local anesthesia, consists of division of the anterior ligament of the public symphysis and part of the inferior ligament (arcuate ligament of the pelvis), while leaving intact the superior ligament or "anatomo-surgical restraint" of Zarate, ensuring limitation of pelvic spread. Symphysiotomy has currently been abandoned by all or almost all teams because of its alleged maternal and fetal morbidity and mortality. We feel, however, that in certain rural areas of third world countries, often ill-equipped and with poor medical services, this procedure can still be very useful in certain exceptional situations in dystocia by moderate feto-pelvic disproportion, in circumstances in which cesarean section is impossible. The experience of the rare teams still using symphysiotomy shows that a degree of disdain is legitimate in face of the ominous reservations expressed as to the possible complications of this procedure.

Dystocia↗
PubMed1981

A retrospective study of matched symphysiotomies and caesarian sections at Port Moresby General Hospital.

The caesarian section rate at Port Moresby General Hospital (PMGH) is 26.7/1000 and the symphysiotomy rate 2.5/1000 deliveries respectively. 40% of the caesarian sections are for cephalopelvic disproportion and in 50% of these cases the diagnosis is made late in labour; it is this group that is compared with the symphysiotomy group. The morbidities of each group are similar, 64% and 62% respectively. The maternal mortality rate in the caesarian section group was 11.6/1000 and the perinatal mortality 160/1000. There were no maternal deaths in the symphysiotomy group and the perinatal mortality rate was 82/1000. It is recommended that symphysiotomy should be more widely accepted as a safe alternative to caesarian section from both the maternal and foetal point of view.

Adult↗
PubMed1990

Safe motherhood: cesarean section or symphysiotomy?

The place of symphysiotomy in the management of cephalopelvic disproportion is discussed on the basis of the existing literature, reviewing maternal mortality and morbidity after symphysiotomy and the vaginal delivery rate in a subsequent pregnancy after a previous symphysiotomy. These are compared with the outcome of cesarean section performed in similar circumstances.

Cesarean Section↗
PubMed1990

Symphysiotomy for the trapped aftercoming parts of the breech: a review of the literature and a plea for its use.

The most dreaded complication of vaginal breech delivery is entrapment of the aftercoming head. When this is due to disproportion, persistent attempts at vaginal extraction are likely to result in a dead or damaged baby. A largely unknown solution in this desperate predicament is to surgically enlarge the pelvis by means of a symphysiotomy. A review of the literature shows that symphysiotomy performed to free the trapped aftercoming head will save at least 80% of babies if the procedure is performed without delay. Every obstetrician should be prepared to perform a symphysiotomy if the aftercoming head is trapped.

Breech Presentation↗
PubMed1995

Symphysiotomy or caesarean section after failed trial of assisted delivery.

The perinatal and maternal outcomes of 65 symphysiotomies and 108 caesarean sections carried out after failed trial of assisted delivery at the Port Moresby General Hospital between 1988 and 1994 were retrospectively analyzed. There were no significant differences in perinatal outcomes between the treatment groups. There were no maternal deaths in either group. Mothers who had symphysiotomy had a longer postoperative stay in hospital but fewer complications requiring further surgery. There are many advantages of symphysiotomy, particularly in developing countries, following a failed trial of assisted delivery, provided the indications for it are strictly met. Obstetricians experienced in the technique are able to apply it at the optimal time, with long-term benefit to their patients, who thereby avoid the risks of pregnancy subsequent to caesarean section.

Apgar Score↗
PubMed1997

Catastrophic shoulder dystocia and emergency symphysiotomy.

We present three cases of shoulder dystocia unrelieved by standard maneuvers, including cephalic replacement. Symphysiotomy was performed in an effort to preserve fetal life. All three infants sustained severe neurologic injury and later died. Maternal morbidity including urinary incontinence was significant but responded to treatment. Symphysiotomy may be the only method of relieving some cases of shoulder dystocia, but its role remains unclear because of operator inexperience and maternal morbidity.

Adult↗
PubMed1994

Value of symphysiotomy in obstructed labour management and follow-up of 31 cases.

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 from 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.

Botswana↗
PubMed1992

Emergency symphysiotomy for the trapped head in breech delivery: indications, limitations and method.

Careful case selection can avoid most obstetrical emergencies. However, even with optimum management of breech labour, the fetal head may become trapped. Since doctors in developing nations must be prepared for this dire situation, this article reviews breech case selection and outlines the steps in breech delivery, illustrating symphysiotomy for the entrapped head. The limitations and precautions associated with symphysiotomy are stressed.

Breech Presentation↗
PubMed1978

Six years' experience of symphysiotomy in a teaching hospital.

One hundred and sixty-one symphysiotomies were performed at Harari Maternity Hospital, Rhodesia, over a 6-year period. Indications for the operation are discussed and fetal and maternal results reviewed. Seventy-two patients suffered from postoperative complications but the majority of these were minor and of short duration. Multiparous patients did not have a higher morbidity than did primiparous ones. It is concluded that symphysiotomy has a useful role to play in a teaching hospital, provided it is performed by an experienced surgeon on carefully selected patients.

Adult↗
PubMed1999

Anderson-Hynes pyeloplasty in horseshoe kidney in children: is it effective without symphysiotomy?

Contemporary reports on surgery for horseshoe kidney (HK) still recommend isthmotomy and lateropexy to complete an open pyeloplasty. To evaluate whether simple Anderson-Hynes pyeloplasty without symphysiotomy is effective for relief of ureteropelvic junction obstruction (UPJO) in HK, we studied the records of ten children, two of whom had bilateral UPJO. Only one child presented with calculi; 11 units were operated upon for UPJO, 1 needed a partial nephrectomy. The surgical outcome was evaluated with emphasis on the changes in renal drainage and function assessed by ultrasonography and diuretic renal scans. Associated vesicoureteral reflux was observed more often (25%) than with UPJO in normal kidneys. Obstruction was caused by a crossing lower-pole vessel in three cases, a high ureteral insertion in two and narrowing of the UPJ 7. Postoperative follow-up (mean 5.5 years) revealed improved renal function and good drainage in all cases. Hydronephrosis vanished in 7, whereas grade 2 hydronephrosis remained in two children with former refluxive megaureter and grade 3 in one. All children are doing well and have no symptoms due to the persistent isthmus (Rovsing syndrome). It is concluded that simple Anderson-Hynes pyeloplasty via a flank incision is a highly effective and safe procedure for treating UPJO in HK.

Child↗
PubMed1999

[Current aspects of symphysiotomy. Apropos of 1 case and review of the literature].

Symphysiotomy is regularly performed in developing countries where cesarean section can be a source of significant short-term and long-term morbidity. However, this method can be useful in some rare occasions and should be taught in our countries, at least theoretically. Such a case is presented with a review describing the present surgical technique, its indications and limits with special reference to its possible complications.

Adult↗
PubMedDate not supplied

[An alternative to cesarean section: symphysiotomy (Zarate's operation)].

The authors explain the technique and the indications of the Zarate's operation. This non-total subcutaneous symphysiotomy eases delivery through natural canals of a cephalic presentation blocked at either the interspinous or at the inferior strait of the pelvis. Such an intervention, almost ignored in France, is really useful in the developing countries. Rather easily performed, it makes possible to limit the necessity of a cesarean section, to prevent both mother and child from serious trauma when instrumental extraction has become necessary in a dystocic pelvis, and finally to reduce the occurrence of vesico-vaginal fistula and hysterorrhexis. On the credit of this method, a special notice must be given to its practicability and to the fact that the uterus remains undamaged. On the other hand, the post-operative recovery is somewhat longer and with more disabling conditions than with the cesarean section; some painful and motor side effects which may last for a rather long time may be imputable to it.

Female↗
PubMed1997

[Symphysiotomy. A thought-provoking example of appropriate technique in the Third World].

Cutting through the symphysis pubis cartilage as a means of widening the birth canal during long, drawn-out deliveries was probably common in Europe at the turn of the century and presumably occurred even later. As a result of progress in hygiene and clinical practice, Caesarean section has become much more common in such situations. In developing countries, where supervision of pregnant women is non-existent or extremely poor, Caesarean section can be a dangerous operation. Mortality figures around 1-3% are common, and the women are left with the unfavourable prognosis of a uterine scar. Therefore, symphysiotomy is still practised in settings where neither hygiene nor material resources permit. Caesarean section, because it is simple to perform and makes a negligible demand on resources.

Contraindications↗