Symphysiotomy and fetal destructive
MBBS, FCOG (SA)
Head of Department
Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of Natal,
Private Bag 7, Congella, 4013 South Africa
Symphysiotomy and fetal destructive operations ± while rarely, if ever, performed in developed
countries ± are an option in developing nations of the world. Problems endemic to developing
countries not infrequently predispose to patients arriving at health care facilities in a moribund
state with neglected labour. The health care provider then has to decide on the options available
to him to deliver the mother by the safest route without incurring morbidity and mortality.
Under the circumstances, the outcome for the baby will depend on factors prevalent at the
time. If the fetus is alive, then the choice is between a Caesarean section and symphysiotomy,
and if the fetus has died, a destructive procedure is an option to abdominal-route delivery which
carries considerable risk to the mother. The following review outlines the role of
symphysiotomy and fetal destructive operations and their role in modern obstetrics.
Key words: symphysiotomy; fetal destruction; obstructed labour; antenatal care.
Neglected labour in industrialized countries is rarely seen in modern obstetrics.
Conversely, the clinical problemof obstructed labour remains a reality in everyday
practice in the developing world. When there is mechanical diculty during labour,
the safest route of delivery is Caesarean section. Throughout the developing world,
where maternal mortality remains high and medical services are minimal, the problem
of managing prolonged obstructed labour is of critical concern. If labour has been
prolonged and neglected, other modes of delivery need to be considered.
Symphysiotomy and fetal destructive operations are options which, if properly
selected and performed, reduce the need for Caesarean section ± which may not be
the correct choice under the circumstances. Suciently skilled sta to undertake
abdominal-route delivery may not be available, nor may the patient have access to
skilled supervision in her subsequent pregnancy if Caesarean section were to be done.
The added risk of overwhelming infection following Caesarean section in patients ±
who invariably are already septicaemic ± makes alternatives a worthwhile proposition.
One such option is the performance of a symphysiotomy: the surgical separation of the
®brocartilaginous symphysis pubis and its reinforcing ligaments with a scalpel. The aim
is to enlarge the diameter of the pelvic opening by dividing a disproportionately small
2002 Elsevier Science Ltd.
Best Practice & Research Clinical Obstetrics and Gynaecology
Vol. 16, No. 1, pp. 117±131, 2002
doi:10.1053/beog.2002.0259, available online at http://www.idealibrary.comon