Symphysiotomy

Symphysiotomy
Intervention
The black area marked by a "5" is the pubic symphysis, which is divided during the procedure
ICD-9-CM	73.94
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Symphysiotomy is a surgical procedure in which the cartilage of the pubic symphysis is divided to widen the pelvis allowing childbirth when there is a mechanical problem. It is also known as pelviotomy,synchondrotomy.

Symphysiotomy was advocated in 1597 by after his description of a diastasis of the pubis on a hanged pregnant woman. Thus symphysiotomies became a routine surgical procedure for women experiencing an obstructed labour. They became less frequent in the late 20th century after the risk of maternal death post-caesarean section decreased due to improvement in techniques, hygiene, and clinical practice.

The most common indications are a trapped head of a breech baby, which does not resolve with routine manoeuvres, and obstructed labor at full cervical dilation when there is no option of a caesarean section. In some Irish cases, caesarean sections were performed after symphysiotomies. Currently the procedure is rarely performed in developed countries, but is still performed in "rural areas and resource-poor settings of developing countries" where caesarian sections are not available, or where obstetricians may not be available to deliver subsequent pregnancies.

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 carries the risks of urethral and bladder injury, fistulas, 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.