Managing Complications in Pregnancy and Childbirth: - IAWG

SYMPHYSIOTOMY P-53Symphysiotomy results in a temporary increase in pelvic diameter (upto 2 cm) by surgically dividing the ligaments of the symphysis underlocal anaesthesia. This procedure should be carried out only incombination with vacuum extraction (page P-27). Symphysiotomy incombination with vacuum extraction is a life-saving procedure in areaswhere caesarean section is not feasible or immediately available.Symphysiotomy leaves no uterine scar and the risk of ruptured uterusin future labours is not increased.These benefits must, however, be weighed against the risks of theprocedure. Risks include urethral and bladder injury, infection, pain andlong-term walking difficulty. Symphysiotomy should, therefore, becarried out only when there is no safe alternative.• Review for indications:- contracted pelvis;- vertex presentation;- prolonged second stage;- failure to descend after proper augmentation;- AND failure or anticipated failure of vacuum extraction alone.• Review conditions for symphysiotomy:- fetus is alive;- cervix is fully dilated;- head at -2 station or no more than 3/5 above the symphysispubis;- no over-riding of the head above the symphysis;- caesarean section is not feasible or immediately available;- the provider is experienced and proficient in symphysiotomy.• Review general care principles (page C-17).• Provide emotional support and encouragement. Use localinfiltration with lignocaine (page C-38).• Ask two assistants to support the woman’s legs with her thighsand knees flexed. The thighs should be abducted no more than 45/from the midline (Fig P-25, page P-54).