Retrospective study from Harare Central Maternity Hospital comparing symphysiotomies with Caesarean Sections for similar indications.

OBJECTIVE

To explore the possibility that in obstructed labour with a live baby, a delivery by symphysiotomy is an ethical option.

DESIGN

Retrospective cohort study.

SETTING

Teaching hospital with busy maternity wards.

SUBJECTS

Women in (nearly) second stage obstructed labour who were either delivered by Caesarean Section (79), or symphysiotomy, (172).

MAIN OUTCOME MEASURES

Comparing perinatal mortality and morbidity and maternal complications, pain, long term morbidity and subsequent reproductive behaviour.

RESULTS

There is no evidence of more foetal mortality or morbidity after a symphysiotomy. Short term maternal morbidity is more serious after Caesarean Section. Long term maternal morbidity might be increased after symphysiotomies, compared with Caesarean Section. Because there are more repeat operative deliveries and trials of scar after a Caesarean Section, future maternal, foetal and infant mortality is higher.

CONCLUSION

Rejection of symphysiotomies as an option for delivery in cases of obstructed labour is not evidence based. It is very likely that lives could be saved if symphysiotomies were taught in the sub-Saharan teaching hospitals and practiced in the district hospitals. Those who oppose symphysiotomies should provide the relevant data.