SYMPHYSIOTOMY

A cut through the symphysis will cause the pubic bones to separate and increase the pelvic circumference with three or more cm (two fingers). Sufficient to resolve a mechanical disproportion due to a large head and/or a narrow pelvis

Indications:

  • Fetal head stuck so firm and deep in the birth canal that C/S is not an option
  • Shoulder dystocia
  • Retained head in breech

To avoid damage to urethra a catheter in the bladder is most important . The urethra with the indwelling catheter is pushed aside when the cut through the symphysis is made.

OPEN SYMPHYSIOTOMY

Preferred method for unexperienced

  • Local infiltration anesthesia
  • Insert a catheter in the bladder
  • Make a 4 to 5 cm long vertical incision through the skin and subcutaneous tissue in front of the symphysis
  • Insert a self-retaining wound retractor
  • With two fingers in the vagina push the urethra to either side
  • Cut strictly in the midline with a scalpel
  • Confirm visually and by palpation that the pubic bones have separated
  • Deliver the baby
  • Close the incision
  • Keep the catheter indwelling for 24 hours
  • Mobilize the patient immediately and without any restrictions

CLOSED SYMPHYSIOTOMY

Preferred method for more experienced

  • Insert a catheter in the bladder
  • Local infiltration anesthesia
  • Use the injection needle to probe and define the exact location of the symphysis
  • Push the urethra to the side with two fingers in the vagina
  • Cut strictly in the midline with a scalpel
  • Confirm by palpation in vagina or suprapubically that the pubic bones have separated
  • Deliver the baby
  • The small incision does not need suturing
  • Keep catheter indwelling for 24 hours
  • Mobilize patient immediately and without any restrictions
Symphysiotomy I
Symphysiotomy II
Symphysiotomy in Breech

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