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Safe motherhood: cesarean section or symphysiotomy?

Abstract：

:The place of symphysiotomy in the management of cephalopelvic disproportion is discussed on the basis of the existing literature, reviewing maternal mortality and morbidity after symphysiotomy and the vaginal delivery rate in a subsequent pregnancy after a previous symphysiotomy. These are compared with the outcome of cesarean section performed in similar circumstances. :To reduce the maternal mortality associated with obstructed labor, the World Health Organization recommended (1986) more widespread use of cesarean section. However, this procedure is itself associated with significant mortality and morbidity risks in health facilities in rural areas of developing countries where obstructed labor due to cephalopelvic disproportion is most prevalent. In some cases of obstructed labor, symphysiotomy--the artificial separation of the symphysis pubis with a scalpel to enlarge the pelvic diameter--is a viable alternative to cesarean section. The maternal mortality associated with this procedure is negligible. In a series of 1752 symphysiotomies in Africa, there were 3 deaths (0.2% mortality rate), and none of these deaths was related to the procedure itself. This compares with a mortality rate for cesarean section in African hospitals of 1.8%. Complications of symphysiotomy can be virtually eliminated if the procedure is performed only when 1/3 or more of the fetal head has entered the pelvic brim, the fetal head is not felt prominent in from of the symphysis, and the cervix is dilated beyond 7 cm. Since this procedure does not scar the uterus, the concern of future uterine rupture that exists with cesarean section is not a factor. The vaginal delivery rate after previous symphysiotomy is 87% compared to 44% after cesarean section for disproportion. Moreover, the need for blood transfusion--with the attendant risk of human immunodeficiency virus infection--is far less in symphysiotomy. Finally, symphysiotomy is more culturally acceptable in developing countries where cesarean section delivery is viewed with stigma as a failure to achieve "natural" vaginal birth.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

van Roosmalen J

doi

10.1016/s0002-9378(11)90653-x

subject

Has Abstract

pub_date

1990-07-01 00:00:00

pages

1-4

issue

1 Pt 1

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(11)90653-X

journal_volume

163

pub_type

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Safe motherhood: cesarean section or symphysiotomy?