Tag: SYMFYSIOTOMY

SHOULDER DYSTOCIA

Posted on by The Rebel Surgeon in SHOULDER DYSTOCIA
  • Do not panic
  • Do not use forceful traction on head
    • May cause severe damage to both child and mother
  • Go systematically through following steps:
  • Wipe baby’s face clean
  • Keep airways free
  • Use suction to remove mucus and meconium
  • Make a generous episiotomy.
    • This alone might solve the problem
  • Apply Loevset’s maneuver
    • Grasp lateral border of the scapula with four ulnar fingers of your hand
    • Rotate truncus 180°
    • Use right hand when the back is turned to the (mother’s) left and vice versa
    • As the birth canal is shorter anteriorly bringing the posterior shoulder anteriorly may deliver it
  • Repeat the maneuver
Loevset’s Maneuver
  • Fracture both clavicles
    • Decreases the overall dimension of the shoulders
  • Place the delivery hook under one axilla
  • Apply traction
  • Rotate truncus 180° (Loevset’s Maneuver)
Loevset’s Maneuver with delivery Hook
  • Perform symphysiotomy

SYMPHYSIOTOMY

Posted on by The Rebel Surgeon in SYMFYSIOTOMY

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