Safe motherhood: cesarean section or symphysiotomy?

Article Abstract:

Obstructed labor is a leading cause of maternal death. Although cesarean section delivery is useful in reducing complications of obstructed labor, it, too, is associated with complications, particularly in developing countries. In fact, the mortality from cesarean section is six times higher in Nigerian hospitals than in hospitals located in Western countries. In most cases of obstructed labor the fetus cannot be accommodated by the mother's pelvis (cephalopelvic disproportion). A procedure not often practiced in the West, symphysiotomy involves separating the pubic symphysis bone to enlarge the diameter of the pelvis and facilitate delivery. Most practicing physicians in developed countries view symphysiotomy as an archaic procedure having no place in modern day obstetrics. Its lack of popularity is based on technical complications encountered during the procedure, which damages urinary and bone structures. A review of 1,752 symphysiotomies uncovered no procedure-related maternal deaths. Procedural complications included 30 (1.7 percent) vesicovaginal fistulas (an abnormal communication between the bladder and the vagina), 33 (1.9 percent) lesions in the wall of the vagina or urethra, 10 (0.6 percent) bone abscesses, 32 (1.8 percent) complications when walking, and 36 (2.1 percent) cases of stress incontinence (involuntary leakage of urine). Some of the complications encountered were caused by labor events and were not related to the procedure itself. The chances of a vesicovaginal fistula are reduced when a urinary catheter is strategically placed. It is concluded that symphysiotomy for the management of cephalopelvic disproportion should be not be abandoned entirely, especially in rural areas of developing countries. The procedure eliminates the risk of uterine rupture by leaving the uterus unscarred. Long-term effects of symphysiotomy are currently being investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Surgery, Nigeria, Obstetrics, Labor, Complicated, Labor complications, Obstetrical surgery

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Fatal meconium aspiration in spite of appropriate perinatal airway management: pulmonary and placental evidence of prenatal disease

Article Abstract:

Meconium aspiration in infants that results in death may occur before birth rather than at the time of birth. Researchers examined medical records and autopsy reports of eight infants who died of meconium aspiration within 48 hours after birth. Even though seven of the infants had their tracheas suctioned at birth, the lungs of all eight showed chronic changes related to lack of oxygen. Six placentas showed abnormalities that could be related to lack of oxygen. These abnormalities were present before birth and may have been more responsible for death than meconium aspiration at birth.

Patient outcomes, Mortality, Meconium aspiration syndrome

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