Symphysiotomy - Surgical Application

Surgical Application

Symphysiotomy results in a temporary increase in pelvic diameter (up to 2 cm) by surgically dividing the ligaments of the symphysis 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. 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.

1. Give appropriate analgesic drugs.
2. Apply elastic strapping across the front of the pelvis from one iliac crest to the other to stabilize the symphysis and reduce pain.
3. Leave the catheter in the bladder for a minimum of 5 days.
4. Encourage the woman to drink plenty of fluids to ensure a good urinary output.
5. Encourage bed rest for 7 days after discharge from hospital.
6. 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.