Symphysiotomy

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...

The art of symphysiotomy for delivery in the instance of cephalopelvic disproportion has been a dying art since the advent of caesarean section but in Ireland this surgical procedure was not abolished until 1992. This practice is still present in the developing world and in some circumstances used in developed countries. This study offers some insights on the 40-year follow-up of patients who had undergone symphysiotomy.

The place of symphysiotomy, as an alternative to Caesarean section (CS), in the management of established obstructed labour in low- and middle-income, resource-poor countries (LMICs), is reviewed. It is suggested that it does have a very definite place, especially in mothers of low age and parity, in circumstances where medical facilities are limited, where antenatal care and hospital delivery are not assured in a future pregnancy, and in cultures where it is important to the woman that a vaginal delivery is achieved...

Hippocrates observed that in women, during childbirth, the iliac bones because of the failure of the joints disconnet and move away from their anchorage. In the 17th and 18h century, doctors plagued with severe and frequent mechanical dystocies, often fatal, devoted themselves to resolve these problem through measures aimed at obtaining a more modest growth of the fetus (thanks to an appropriate maternal nutrition, or induction of preterm birth) and both encouraging artificially and strengthening the natural pelvic collapse descripted by Hippocrates...

No abstract text is available yet for this article.

Symphysiotomy to manage shoulder dystocia is seldom used in the western world. For this reason, in well-resourced countries knowledge of its recuperation rate and the management of physical discomfort in the post-partum period is scarce. We describe two cases of symphysiotomy for shoulder dystocia. Both babies did very well in the postpartum period. The short-term 6-week and 6-month follow-up of both mothers is described. Short-term maternal complications were minor and based on prolonged immobilization. In accordance with the international literature, the short-term and long-term follow-up after symphysiotomy for shoulder dystocia was good and there were no major maternal or neonatal complications...

BACKGROUND: In patients undergoing hemipelvectomies including resection either of a portion of the pubis or the entire pubis from the symphysis to the lateral margin of the obturator foramen while sparing the hip (so-called Dunham Type III hemipelvectomies), reconstructions typically are not performed given the preserved continuity of the weightbearing axis and the potential complications associated with reconstruction. Allograft reconstruction of the pelvic ring may, however, offer benefits for soft tissue reconstruction of the pelvic floor and hip stability, but little is known about these reconstructions...

No abstract text is available yet for this article.

This paper presents 35 years of history of operative vaginal delivery at the Port Moresby General Hospital (PMGH). From the early 1970s when Dr. G.C. Bird was appointed as Head of Obstetrics at PMGH, vacuum extraction has been the preferred method of assisted vaginal delivery. In the early 1970s, Dr Bird began to experiment with more effective configurations of the then standard metal Malmstrom vacuum extraction cup: the Bird anterior cup was introduced in 1973 and the posterior cup in 1974. These modifications to the vacuum extractor cup allowed for more effective placement of the cup on the flexion point on the fetal head thereby facilitating more successful vacuum-assisted delivery...

Coexistence of horseshoe kidney and abdominal aortic aneurysm (AAA) is a rare entity that presents a technical challenge to vascular surgeons. How to approach such an AAA with horseshoe kidney and whether to divide the renal isthmus remains a controversial issue. We report here the successful surgical repair of an AAA with horseshoe kidney via the transperitoneal approach with division of the renal isthmus by Harmonic Focus, which allowed easy division of the isthmus without bleeding. Harmonic Focus, a hand-held type of harmonic scalpel, was thus useful in symphysiotomy of the horseshoe kidney...

BACKGROUND: Pubic symphysiotomy is a rarely performed procedure in which the pubic symphysis is divided to facilitate vaginal delivery in cases of obstructed labor. Recently, many obstetricians have shown renewed interest in this procedure. The purpose of this paper is to report the long-term radiographic findings for patients who had undergone pubic symphysiotomy compared with the radiographic appearance of a group of age-matched and parity-matched controls. METHODS: This was a retrospective case-control study...

OBJECTIVE: To describe the effect abaxial retraction after pelvic symphysiotomy has on the geometry of the sacroiliac joints (SIs) in dogs. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Canine cadavers (n = 9). METHODS: Canine cadavers free of sacroiliac disease had pelvic symphysiotomy and retraction to 25%, 50%, 75%, and 100% of transverse sacral width, followed by axial reduction of the symphysis. Before symphysiotomy, after each abaxial retraction value, and after reduction of the symphysis each SI joint had a computed tomographic scan to evaluate the effect on the SI joints...

INTRODUCTION: The objective of this study is to clarify whether symphysiotomy is an essential procedure combined with the laparoscopic pyeloplasty for the surgical treatment of ureteropelvic junction obstruction related to horseshoe kidney. METHODS: We retrospectively reviewed five horseshoe kidney patients with symptomatic hydronephrosis who underwent laparoscopic transperitoneal Anderson-Hynes pyeloplasty without symphysiotomy between July 2002 and October 2011...

Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions thereby facilitating vaginal delivery of the foetus in the presence of mild to moderate cephalopelvic disproportion. It is performed with local anaesthesia, does not require an operating theatre or advanced surgical skills. It can be a lifesaving procedure for both mother and baby in obstructed labour, especially in rural areas and resource-poor settings of developing countries, where a 24 hours availability of a caesarean section cannot be guaranteed...

BACKGROUND: Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions during childbirth. It is performed with local analgesia and does not require an operating theatre nor advanced surgical skills. It may be a lifesaving procedure for the mother or the baby, or both, in several clinical situations. These include: failure to progress in labour when caesarean section is unavailable, unsafe or declined by the mother; and obstructed birth of the aftercoming head of a breech presenting baby...

INTRODUCTION: Rectal foreign bodies (RFB) present the modern surgeon with a difficult management dilemma, as the type of object, host anatomy, time from insertion, associated injuries and amount of local contamination may vary widely. Reluctance to seek medical help and to provide details about the incident often makes diagnosis difficult. Management of these patients may be challenging, as presentation is usually delayed after multiple attempts at removal by the patients themselves have proven unsuccessful...

Should the indications for therapies differ from one nation to the next? What are the reasons behind controversial therapeutic variations? What roles do cultural history and authoritarian conflict among clinicians play in the adoption of therapies? When I worked at a rural hospital in Kenya, a woman experiencing obstructed labor made me ponder many questions-but only after our emergency ended in the death of her newborn son. In recounting and learning from this episode, I listened to the disparate Kenyan voices of the patient, the hospital's director, the consultant obstetrician, and to the even more controversial voices of evidence-based medicine...

AIMS AND OBJECTIVES: To review the indications, outcome and complications of symphysiotomy done in Federal Medical Centre Umuahia during the study period. PATIENTS AND METHODS: This study is a 5-year review of all women who had symphysiotomy at Federal Medical Centre Umuahia. The total number of the procedure performed, and all the deliveries conducted at the hospital in the study period were obtained from the labour ward register. The case notes of the patients were then retrieved and their biodata and other relevant information were obtained and summarized in frequency tables and percentages...

OBJECTIVES: To describe mortality related to Caesarean sections as well as factors associated with these deaths. DESIGN: Retrospective cross-sectional. SETTING: Seven district hospitals in Matebeleland North. MAIN OUTCOME MEASURES: Proportion of Caesarean sections that resulted in maternal deaths, and the causes thereof. RESULTS: 1093 Caesarean sections were carried out over a 3 year period; 18 women (1...

Symphysiotomy is an alternative operative procedure where a deliberate division of symphysis pubis is carried out to facilitate delivery in cases of cephalopelvic disproportion, so as to permit the birth of baby by natural passages. Symphysiotomy results in a permanent increase in pelvic diameter (up to 1 cm) by surgically dividing the ligaments of the symphysis under local or general anaesthesia. Symphysiotomy should only be done in a established case of obstructed labour but not in anticipation of obstructed labour...