Symphysiotomy

Symphysiotomy is a surgical procedure that involves the division of the pubic symphysis, which is the joint that unites the left and right pubic bones. This procedure was historically performed to facilitate childbirth in cases where a caesarean section was not possible or advisable.

History

Symphysiotomy was first described in the 18th century by French obstetrician Jean-René Le Fort. It was initially used in cases of obstructed labour due to a narrow pelvis, before the advent of safe caesarean sections. The procedure fell out of favour in the 20th century as caesarean sections became safer and more widely available. However, it continued to be performed in some countries, notably Ireland, into the late 20th century.

Procedure

During a symphysiotomy, the patient is placed in a lithotomy position. A small incision is made above the pubic symphysis, and the fibres of the joint are divided with a scalpel. This allows the pubic bones to separate and increases the diameter of the pelvis, facilitating childbirth.

Complications

Symphysiotomy is associated with a number of potential complications, including urinary incontinence, pelvic pain, and sexual dysfunction. Long-term complications can include osteoarthritis of the pubic symphysis and pelvic instability.

Controversy

The continued use of symphysiotomy in Ireland into the late 20th century has been the subject of controversy and legal action. Many women who underwent the procedure were not informed of the risks, and have suffered long-term complications as a result.

See also

• Obstetric fistula
• Vesicovaginal fistula
• Obstructed labour

References

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  Diagram of the skeletal pelvis showing the pubis
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  Postoperative treatment illustration from 1907