Symphysiotomy
Encyclopedia
Symphysiotomy is a surgical procedure in which the cartilage
of the pubic symphysis
is divided to widen the pelvis
allowing childbirth
when there is a mechanical problem.
on a hanged pregnant
woman . Thus symphysiotomies became a routine surgical procedure for women experiencing an obstructed labour. In the late 19th century after the risk of maternal death after caesarean section
decreased due to improvement in techniques, hygiene and clinical practice the symphysiotomy was used less.
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.
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. Since this procedure does not scar the uterus
, the concern of future uterine rupture that exists with cesarean section is not a factor.
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. Managing complcations in Pregnancy and Childbirth: A guide for Midwives and Doctors [World Health Organization] It is advised that this procedure should not be repeated due to the risk of gait
problems and continual pain.
Abduction of the thighs more than 45 degrees from the midline may cause tearing of the urethra and bladder.
If long-term walking difficulties and pain are reported (occur in 2% of cases), treat with physical therapy.Managing complcations in Pregnancy and Childbirth: A guide for Midwives and Doctors [World Health Organization]
Minister for Health and Children
Mary Harney
ruled out a review on February 19, 2010.
Cartilage
Cartilage is a flexible connective tissue found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs...
of the pubic symphysis
Pubic symphysis
The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...
is divided to widen the pelvis
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
allowing childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
when there is a mechanical problem.
Introduction
Symphysiotomy was advocated in 1597 by Severin Pineau after his description of a diastasis of the pubisDiastasis symphysis pubis
Diastasis symphysis pubis is the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture.- Diagnosis :...
on a hanged pregnant
woman . Thus symphysiotomies became a routine surgical procedure for women experiencing an obstructed labour. In the late 19th century after the risk of maternal death after caesarean section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
decreased due to improvement in techniques, hygiene and clinical practice the symphysiotomy was used less.
Indications for the procedure
The most common indications are a trapped head of a breech baby, shoulder dystociaShoulder dystocia
Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly...
which does not resolve with routine manoeuvres and obstructed labour at full cervical dilation
Cervical dilation
Cervical dilation is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery...
when there is no option of a caesarean section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
. Currently the procedure is rarely performed in developed countries, but is still routine in developing countries where caesarean section is not always an option.
Surgical application
Symphysiotomy results in a temporary increase in pelvic diameter (up to 2 cm) by surgically dividing the ligaments of the symphysisSymphysis
A symphysis is a fibrocartilaginous fusion between two bones. It is a type of cartilaginous joint, specifically a secondary cartilaginous joint.1.A symphysis is an amphiarthrosis, a slightly movable joint.2.A growing together of parts or structures...
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. Since this procedure does not scar the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
, the concern of future uterine rupture that exists with cesarean section is not a factor.
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. Managing complcations in Pregnancy and Childbirth: A guide for Midwives and Doctors [World Health Organization] It is advised that this procedure should not be repeated due to the risk of gait
Gait
Gait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency...
problems and continual pain.
Abduction of the thighs more than 45 degrees from the midline may cause tearing of the urethra and bladder.
- Give appropriate analgesic drugs.
- Apply elastic strapping across the front of the pelvis from one iliac crest to the other to stabilize the symphysis and reduce pain.
- Leave the catheter in the bladder for a minimum of 5 days.
- Encourage the woman to drink plenty of fluids to ensure a good urinary output.
- Encourage bed restBed restBed rest is a medical treatment involving a period of consistent recumbence in bed. It is used as a treatment for an illness or medical condition, especially when prescribed or chosen rather than resulting from severe prostration or imminent death...
for 7 days after discharge from hospital. - 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.Managing complcations in Pregnancy and Childbirth: A guide for Midwives and Doctors [World Health Organization]
Symphysiotomy in Ireland
Irish women who unknowingly and without consent underwent symphysiotomies during childbirth between the 1950s and 1980s say they were left with severe side effects, including extreme pain, impaired mobility, incontinence and depression.Minister for Health and Children
Minister for Health and Children (Ireland)
The Minister for Health is the senior minister at the Department of Health in the Government of Ireland and is responsible for health care in the Republic of Ireland and related services.The current Minister for Health is James Reilly, TD...
Mary Harney
Mary Harney
Mary Harney is a former Irish politician. She served as Tánaiste from 1997–2006, Minister for Enterprise, Trade and Employment from 1997–2004, and as Minister for Health and Children from 2004 to 2011...
ruled out a review on February 19, 2010.