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
OBSTETRICS 