The perinatal and maternal outcomes of 65 symphysiotomies and 108 caesarean sections carried out after failed trial of assisted delivery at the Port Moresby General Hospital between 1988 and 1994 were retrospectively analyzed. There were no significant differences in perinatal outcomes between the treatment groups. There were no maternal deaths in either group. Mothers who had symphysiotomy had a longer postoperative stay in hospital but fewer complications requiring further surgery. There are many advantages of symphysiotomy, particularly in developing countries, following a failed trial of assisted delivery, provided the indications for it are strictly met. Obstetricians experienced in the technique are able to apply it at the optimal time, with long-term benefit to their patients, who thereby avoid the risks of pregnancy subsequent to caesarean section.
PIP: A retrospective analysis of 65 symphysiotomies and 108 cesarean sections performed in 1988-94 after a failed trial of assisted delivery at the Port Moresby General Hospital (Papua New Guinea) revealed no significant differences in perinatal or maternal outcomes. There were no significant differences between groups in terms of duration of first and second-stage labor, Apgar scores, admission to a special care neonatal unit, or perinatal mortality. There were no maternal deaths. Mothers who had symphysiotomy required a longer hospital stay, but had fewer complications necessitating additional surgery (e.g., wound infection) than women delivered by cesarean section. These findings confirm that, with proper technique and selection of cases, symphysiotomy can both eliminate difficult vaginal deliveries and reduce maternal morbidity and mortality. Indications for this procedure include presentation of the vertex, moderate cephalopelvic disproportion, and a live fetus. The main complications are leg and pelvic pain, pelvic instability, and stress incontinence.