Symphysiotomy

 Symphysiotomy 

This is enlargement of the pelvis by cutting of the symphysis pubis fibre to allow vaginal delivery in the presence of moderate disproportion. It is done when facilities for Caesarean Section are not available or to avoid rupture of uterus at a previous Caesarean Section scar. The fetus must be alive. It is done late in labour. Usually for a primigravida.

 

·              Make a stab incision on the symphysis pubis.

 

·              Deliver the baby immediately by vacuum to.

 

After care:

1.           The pelvis is supported with broad strips of elastoplast.

 

2.           The legs are strapped together for 12 hours.

 

3.           Patient is kept in bed, nursed on her side for 3 days.

 

4.           Catheter remains for 4 – 5 days, the catheter is th en removed and she is allowed to sit out of bed. 

 

5.           Ambulation starts on the 5th day with walking sticks.

 

6.           She should avoid undue muscular effort and lifting of weight for at least one month.

 

Complications

1.           Soft tissue damage – bladder neck and urethra.

 

2.           Vesico Vaginal Fistula –VVF.

 

3.           Pelvic joint and back pains

 

4.           Difficulty in walking may persist for a long time.

 

5.           Sepsis and haematoma at the site of operation.

 

6.           Pelvic instability during subsequent pregnancies causing pubic and back pains.

 

7.           The procedure is outdated and has been replaced by C/S.