Symphysiotomy

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Symphysiotomy

  1. 1. Symphysiotomy<br />www.freelivedoctor.com<br />
  2. 2. Symphysiotomy<br />Definitions<br /> * Symphysiotomy: is division of the symphysis pubis with a scalpel.<br />* 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.<br />www.freelivedoctor.com<br />
  3. 3. Indications<br />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<br />www.freelivedoctor.com<br />
  4. 4. Indications<br />As symphysiotomy gives a permanent increase of the pelvic capacity, it can be an alternative to C.S. and indicated in the following conditions:<br />* Moderate cephalopelvic disproportion.<br />* Contracted outlet in funnel shaped pelvis.<br />* Retained aftercoming head in breech delivery failed to be delivered by other means.<br />* Shoulder dystocia with a living foetus cannot be delivered by other means.<br />www.freelivedoctor.com<br />
  5. 5. Procedure<br />Subcutaneous symphysiotomy is the commonly done operation and done as follow:<br />* A firm catheter is applied and the urethra is displaced to one side with two fingers in the vagina.<br />* A 1-2 cm vertical suprapubic incision is made with a scalpel just above the symphysis.<br />* 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.<br />www.freelivedoctor.com<br />
  6. 6. Procedure<br />* 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.<br />*The thighs are held by assistants so that abduction and joint separation can be controlled.<br />www.freelivedoctor.com<br />
  7. 7. Procedure<br />* A large episiotomy is required to minimise strain on the soft tissue anteriorly.<br />* Forceps or preferably, ventouse is used to deliver the foetus.<br />* The skin incision is closed by one or two sutures.<br />www.freelivedoctor.com<br />
  8. 8. Postoperative<br />* Rest for 2 weeks.<br />* A tight binder of "Elastoplast" is strapped around the pelvic girdle and hips.<br />* Bladder drainage is continued for 3-4 days.<br />* A prophylactic antibiotic may be given.<br />www.freelivedoctor.com<br />
  9. 9. Complications<br />* Haemorrhage, compression for few minutes usually stop it.<br />* Injury to the urethra or bladder.<br />* Vesico-vaginal or urethro-vaginal fistula.<br />* Stress incontinence.<br />* Sepsis.<br />* Pelvic osteoarthropathy.<br />* Difficulty of walking and unstable pelvis usually improved by time.<br />www.freelivedoctor.com<br />

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