Minimally invasive surgery for obstructed labour: a review of symphysiotomy during the twentieth century (including 5000 cases)

Objective To compile and make available essential data on symphysiotomy for evaluation in the struggle against maternal and fetal mortality and morbidity from obstructed labour, which causes the death of 50,000 women each year in low-resourced countries. Design Retrospective review of literature. Sample Five thousand symphysiotomies and 1200 caesarean sections from 28 countries on four continents. Methods The review is based on original papers published 1900 to 1999, stepwise traced through reference lists. Inclusion criteria were: firstly, that the cases reported be consecutive, secondly the presence of an acceptable description of methodology and thirdly, the study size was set at a minimum of 25 cases for analysis of maternal and fetal mortality. Papers comprising only five to 24 cases were included in other analyses. All studies were retrospective, except the follow up studies. Main outcome measures Maternal and fetal mortality; causes of maternal death; fetal mortality in previous deliveries; mode of delivery in subsequent pregnancies; symphyseal width after symphysiotomy; immediate, short and long term complications; maternal and fetal mortality comparing symphysiotomy and caesarean section. Results Symphysiotomy has been extensively studied, modified and refined over the last century, and the scientific documentation is substantial. The results indicate that symphysiotomy is safe for the mother from a vital perspective, confers a permanent enlargement of the pelvis and facilitates vaginal delivery in future pregnancies, and is a life saving operation for the child. Severe complications are rare. Symphysiotomy compares favourably with caesarean section in terms of risk for the mother's life. Conclusion If valid conclusions can be drawn from one hundred years of retrospective studies, there is considerable evidence to support a reinstatement of symphysiotomy in the obstetric arsenal, for the benefit of women in obstructed labour and their offspring.