Symphysiotomy- a dying art: the experience at Federal Medical Centre Umuahia Nigeria.

AIMS AND OBJECTIVES: To review the indications, outcome and complications of symphysiotomy done in Federal Medical Centre Umuahia during the study period. PATIENTS AND METHODS: This study is a 5-year review of all women who had symphysiotomy at Federal Medical Centre Umuahia. The total number of the procedure performed, and all the deliveries conducted at the hospital in the study period were obtained from the labour ward register. The case notes of the patients were then retrieved and their biodata and other relevant information were obtained and summarized in frequency tables and percentages. RESULTS: Ten (10) symphysiotomies were performed among 3702 deliveries conducted during the period under review giving a rate of 0.27%. Seventy per cent of the patients were aged 30 years and below, mean age was 26 (± SD4.9) years. Most of the patients were multiparous women, only one was grandmultiparous. All were for mild to moderate cephalopelvic disproportion (CPD). In one particular case, the patient also presented with retained second twin. They were all unbooked patients. Main complication was pelvic and leg pain but there were two cases of vesicovaginal fistula which may be a complication of obstructed labour since leakage of urine did not start immediately after the procedure. The birth weight of the babies ranged from 3kg to 4.2kg. There was no maternal mortality but two fresh stillbirths were recorded giving a perinatal mortality rate of 200 per 1000 total births. CONCLUSION: Symphysiotomy if done by a trained person, in well selected patients is still safe and can be life saving in environments where caesarean delivery is not well accepted and late presentation is common.

Does a preference for symphysiotomy over caesarean section reduce the operative delivery rate?

We analysed the data from a hospital that had practiced symphysiotomy and caesarean section (c/s) for many years and where symphysiotomy was acceptable to the parturient women, in order to determine the effects of symphysiotomy on c/s and on the overall operative delivery rates. Regression analysis revealed significant negative correlation between symphysiotomy and c/s (R = -0.610, P = 0.03 at 95% confidence interval [CI]) and a non-significant negative correlation between symphysiotomy and combined operative deliveries (R = -0.108, P = 0.383 at 5% CI). This study has confirmed that, in our environment, the practice of symphysiotomy significantly reduces the c/s rate and may save some women from operative deliveries in subsequent pregnancies. With the widespread aversion for c/s in the developing countries and a preference for symphysiotomy in some communities, symphysiotomy should be offered as an alternative to c/s whenever possible. Urgent revival of the dying skill of symphysiotomy is recommended in developing countries.

Symphysiotomy at the Mater Misericordiae Hospital Afikpo, Ebonyi State of Nigeria (1982-1999): a review of 1013 cases.

One thousand and thirteen (1013) symphysiotomies were performed and 27,477 deliveries were conducted during the period. The symphysiotomy rate in the study period was 3.7%. Fifty-six percent (56%) of the patients who had symphysiotomy were aged 39 years and below, and the mean age was 27.94 +/- 7.16 years. Mothers with maternal age greater than 40 years were at a higher risk for symphysiotomy. Thirty-eight percent (38%) of those who had symphysiotomy were nulliparae, 35% were multiparae, while grandmultiparae accounted for 27%. Cephalopelvic disproportion was the leading indication for symphysiotomy (88%), while arrest of the after-coming head of the breech and previous caesarean section with mild cephalopelvic disproportion were other indications for symphysiotomy. Transient post-operative pelvic and leg pain was the leading maternal complication in the study, while stress incontinence, para urethra/vagina lacerations and vesico-vagina fistula were the other complications highlighted. In the study, 69% of the symphysiotomies performed were for babies with birth weight between 3.0 and 3.9 kg. The record of one maternal death was available and was from massive pulmonary embolism on the third day postpartum. There were 104 perinatal deaths with a perinatal mortality rate of 108.7 per 1000 total births.