Symphysiotomy for obstructed labour: a systematic review and meta‐analysis

Wilson, Amie; Truchanowicz, Ewa; Elmoghazy, Diaa A.M.; MacArthur, Christine

doi:10.1111/1471-0528.14040

Cited by 11 publications

(4 citation statements)

References 26 publications

(130 reference statements)

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“…Of course, this position ignores the role of the numerous hormonal and neurotransmitter changes during the last hours of pregnancy and delivery. An excellent representation of the ignorance of some gynecologists has been well represented by the symphysiotomy, or Zarate's operation [84], and by the episiotomy itself [85,86]. The two operations are very rarely needed, and the large majority of these interventions done in the past were based on ignorance, misogyny, and prejudices against female sexuality.…”

Section: Discussionmentioning

confidence: 99%

Do We Still Believe There Is a G-spot?

Mollaioli

Sansone

Colonnello

et al. 2021

Curr Sex Health Rep

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In the field of female sexuality, the existence of the so-called “G-spot” represents a topic still anchored to anecdotes and opinions and explained using non-scientific points, as well as being overused for commercial and mediatic purposes. Purpose of Review The scope of this review is to give an update on the current state of information regarding the G-spot and suggesting potential future directions in the research field of this interesting, albeit controversial, aspect of human sexual physiology. Recent Findings From evolutionary, anatomical, and functional points of view, new evidence has rebutted the original conceptualization of the G-spot, abandoning the idea of a specific anatomical point able to produce exceptional orgasmic experiences through the stimulation of the anterior vaginal wall, the site where the G-spot is assumed to be. From a psychological perspective, only few findings to date are able to describe the psychological, behavioral, and social correlates of the pleasure experience by G-spot-induced or, better, vaginally induced orgasm (VAO). Summary Recent literature suggests the existence of a G-spot but specifies that, since it is not a spot, neither anatomically nor functionally, it cannot be called G, nor spot, anymore. It is indeed a functional, dynamic, and hormone-dependent area (called clitorourethrovaginal, CUV, complex), extremely individual in its development and action due to the combined influence of biological and psychological aspects, which may trigger VAO and in some particular cases also female ejaculation (FE).

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Section: Discussionmentioning

confidence: 99%

Do We Still Believe There Is a G-spot?

Mollaioli

Sansone

Colonnello

et al. 2021

Curr Sex Health Rep

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“…This surgical procedure will dramatically increase the pelvic outlet and the size of the pelvic by 2.5cm to allow normal vaginal delivery of a baby. (Wilson et al, 2016;Holmer et al, 2019;Ersdal et al, 2008;Gebbie, 1966) Symphysiotomy can be done as an alternative procedure to reduce the mortality and morbidity of mother and newborn with obstructed labor, but it doesn't require innovative surgical skills like caesarian section and it can be performed under local anesthesia by a well-trained midwife, clinical of icer, and surgeon. (Fasubaa et al, 2002;Basak et al, 2011) Post-operative care usually consists of applying elastic strapping to stabilize the pelvis and reduce the pain.…”

Section: Discussionmentioning

confidence: 99%

Symphysiotomy Using Posterior Approach

Alqahtani¹,

Al-Qahtani²

2021

ijrps

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The invention relates to an apparatus used in the separation of the Symphysis pubis joint from its posterior aspect. This process medically named as Symphysiotomy. The apparatus consists of 3 parts: (1). Size 14G cannula which is 14cm in length, made of stainless steel and has a sharp bevel and thickened posterior part to enable the user to have a good grip on it during usage. (2). A stylet 14cm long made of stainless steel to fit in the inside of the cannula to prevent coring of the tissues during the introduction of the cannula. It has a vertical end to stop the advancement inside the cannula. (3). A cutter which is 14cm long and made of stainless steel and fits inside the cannula when the stylet is removed. Its front part is sharp on one side to cut through the ligament and cartilage of the symphysis pubis from its posterior aspect. Its back has a half-circle end to prevent the cutter from advancing beyond the bevel of the cannula inside the tissues. This is a life-saving operation and used to widen the diameter of the pelvis during certain situations of obstructed delivery of the baby. The design of the apparatus and instructions of its use enable doctors and midwives to perform the symphysiotomy procedure once they are trained on its use. The use of the invention avoids bleeding, injury to urethra and bladder, and avoids the formation of skin scar. The symphysiotomy scalpel obtained patent status from the King Abdulaziz City for Science & Technology (5910 dated 20 May 2018).

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“…Surgical delivery must not be the only available solution for complicated deliveries, yet assisted vaginal delivery (vacuum extraction or other instrumental delivery) is underused in Sierra Leone 36 58 59. In some cases, such methods may be safer alternatives to caesarean section, and the option of symphysiotomy has been discussed in the obstetric literature 60. Furthermore, in certain cases of intrauterine fetal death, destructive operations (such as craniotomy) could have been an alternative to caesarean section, to spare the mother the risks and complications of the procedure and the increased risk of complications from subsequent deliveries.…”

Section: Discussionmentioning

confidence: 99%

The rate and perioperative mortality of caesarean section in Sierra Leone

et al. 2019

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IntroductionSierra Leone has the world’s highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country.MethodsWe conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality.ResultsIn 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0–2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed.ConclusionsThe caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.

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Symphysiotomy for obstructed labour: a systematic review and meta‐analysis

Cited by 11 publications

References 26 publications

Do We Still Believe There Is a G-spot?

Do We Still Believe There Is a G-spot?

Symphysiotomy Using Posterior Approach

The rate and perioperative mortality of caesarean section in Sierra Leone

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