Managing Complications in Pregnancy and Childbirth: - IAWG

P-54 SymphysiotomyAbduction of the thighs more than 45/ from the midline maycause tearing of the urethra and bladder.FIGURE P-25Position of the woman for symphysiotomy• Perform a mediolateral episiotomy (page P-71). If an episiotomy isalready present, enlarge it to minimize stretching of the vaginal walland urethra.• Infiltrate the anterior, superior and inferior aspects of thesymphysis with lignocaine 0.5% solution (page C-39).Note: Aspirate (pull back on the plunger) to be sure that no vesselhas been penetrated. If blood is returned in the syringe withaspiration, remove the needle. Recheck the position carefully andtry again. Never inject if blood is aspirated. The woman can sufferseizures and death if IV injection occurs.• At the conclusion of the set of injections, wait 2 minutes and thenpinch the incision site with forceps. If the woman feels the pinch,wait 2 more minutes and then retest.Anaesthetize early to provide sufficient time for effect.• Insert a firm catheter to identify the urethra.