Symphysiotomy
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  • 1. Symphysiotomy
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  • 2. Symphysiotomy
    Definitions
    * Symphysiotomy: is division of the symphysis pubis with a scalpel.
    * Pubiotomy: is division of the pubic ramus half an inch from the symphysis pubis with a Gigli saw to avoid injury to the urethra and bladder. It is out of modern obstetrics due to higher incidence of pubic pain and infection.
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  • 3. Indications
    It is particularly indicated in women living in distant areas where caesarean section cannot be done and even patient will be left with a caesarean scar is in a high risk of rupture in the next labou
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  • 4. Indications
    As symphysiotomy gives a permanent increase of the pelvic capacity, it can be an alternative to C.S. and indicated in the following conditions:
    * Moderate cephalopelvic disproportion.
    * Contracted outlet in funnel shaped pelvis.
    * Retained aftercoming head in breech delivery failed to be delivered by other means.
    * Shoulder dystocia with a living foetus cannot be delivered by other means.
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  • 5. Procedure
    Subcutaneous symphysiotomy is the commonly done operation and done as follow:
    * A firm catheter is applied and the urethra is displaced to one side with two fingers in the vagina.
    * A 1-2 cm vertical suprapubic incision is made with a scalpel just above the symphysis.
    * The scalpel is introduced through the incision to the upper border of the symphysis with its sharp edge facing anteriorly i.e. towards the operator.
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  • 6. Procedure
    * The joint is gradually divided by a rocking motion, checking with the vaginal fingers for posterior perforation of the joint capsule. Complete division is rarely, if ever,required.
    *The thighs are held by assistants so that abduction and joint separation can be controlled.
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  • 7. Procedure
    * A large episiotomy is required to minimise strain on the soft tissue anteriorly.
    * Forceps or preferably, ventouse is used to deliver the foetus.
    * The skin incision is closed by one or two sutures.
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  • 8. Postoperative
    * Rest for 2 weeks.
    * A tight binder of "Elastoplast" is strapped around the pelvic girdle and hips.
    * Bladder drainage is continued for 3-4 days.
    * A prophylactic antibiotic may be given.
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  • 9. Complications
    * Haemorrhage, compression for few minutes usually stop it.
    * Injury to the urethra or bladder.
    * Vesico-vaginal or urethro-vaginal fistula.
    * Stress incontinence.
    * Sepsis.
    * Pelvic osteoarthropathy.
    * Difficulty of walking and unstable pelvis usually improved by time.
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