-
The Cochrane Database of Systematic... Oct 2012Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic... (Review)
Review
BACKGROUND
Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions during childbirth. It is performed with local analgesia and does not require an operating theatre nor advanced surgical skills. It may be a lifesaving procedure for the mother or the baby, or both, in several clinical situations. These include: failure to progress in labour when caesarean section is unavailable, unsafe or declined by the mother; and obstructed birth of the aftercoming head of a breech presenting baby. Criticism of the operation because of complications, particularly pelvic instability, and as being a 'second best' option has resulted in its decline or disappearance from use in many countries. Several large observational studies have reported high rates of success, low rates of complications and very low mortality rates.
OBJECTIVES
To determine, from the best available evidence, the effectiveness and safety of symphysiotomy versus alternative options for obstructed labour in various clinical situations.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 July 2012).
SELECTION CRITERIA
Randomized trials comparing symphysiotomy with alternative management, or alternative techniques of symphysiotomy, for obstructed labour or obstructed aftercoming head during breech birth.
DATA COLLECTION AND ANALYSIS
Planned methods included evaluation of studies against objective quality criteria for inclusion, extraction of data, and analysis of data using risk ratios or mean differences with 95% confidence intervals. The primary outcomes were maternal death or severe morbidity, and perinatal death or severe morbidity.
MAIN RESULTS
We found no randomized trials of symphysiotomy.
AUTHORS' CONCLUSIONS
Because of controversy surrounding the use of symphysiotomy, and the possibility that it may be a life-saving procedure in certain circumstances, professional and global bodies should provide guidelines for the use (or non-use) of symphysiotomy based on the best available evidence (currently evidence from observational studies). Research is needed to provide robust evidence of the effectiveness and safety of symphysiotomy compared with no symphysiotomy or comparisons of alternative symphysiotomy techniques in clinical situations in which caesarean section is not available; and compared with caesarean section in clinical situations in which the relative risks and benefits are uncertain (for example in women at very high risk of complications from caesarean section).
Topics: Cephalopelvic Disproportion; Female; Humans; Pelvimetry; Pregnancy; Pubic Symphysis; Symphysiotomy
PubMed: 23076913
DOI: 10.1002/14651858.CD005299.pub3 -
Frontiers in Surgery 2022Femoroacetabular impingement syndrome (FAIS) is an increasingly prevalent pathology in young and active patients, that has contributing factors from both abnormal hip... (Review)
Review
Femoroacetabular impingement syndrome (FAIS) is an increasingly prevalent pathology in young and active patients, that has contributing factors from both abnormal hip morphology as well as abnormal hip motion. Disease progression can be detrimental to patient quality of life in the short term, from limitations on sport and activity, as well as the long term through early onset of hip arthritis. However, several concurrent or contributing pathologies may exist that exacerbate hip pain and are not addressed by arthroscopic intervention of cam and pincer morphologies. Lumbopelvic stiffness, for instance, places increased stress on the hip to achieve necessary flexion. Pathology at the pubic symphysis and sacroiliac joint may exist concurrently to FAIS through aberrant muscle forces. Additionally, both femoral and acetabular retro- or anteversion may contribute to impingement not associated with traditional cam/pincer lesions. Finally, microinstability of the hip from either osseous or capsuloligamentous pathology is increasingly being recognized as a source of hip pain. The present review investigates the pathophysiology and evaluation of alternate causes of hip pain in FAIS that must be evaluated to optimize patient outcomes.
PubMed: 36034352
DOI: 10.3389/fsurg.2022.697488 -
Journal of Clinical Orthopaedics and... Mar 2022Percutaneous techniques are commonly used to treat pelvic ring disruptions but are not mainstream for fixation of pubic symphysis disruption worldwide. Potential...
BACKGROUND
Percutaneous techniques are commonly used to treat pelvic ring disruptions but are not mainstream for fixation of pubic symphysis disruption worldwide. Potential advantages include less blood loss and lower risk of surgical site infection, especially in the morbidly obese or multiply injured patient. This study was performed to describe the clinical and radiographic outcomes of patients after percutaneous reduction and screw fixation of pubic symphysis disruption and to evaluate the preliminary safety and efficacy of this technique and its appropriateness for further study as an alternative method of fixation.
METHODS
A retrospective review was performed to identify all patients who underwent percutaneous fixation of pubic symphysis disruption by two surgeons at an academic Level I trauma center over a 3-year period. Patients underwent percutaneous reduction and fixation of the pubic symphysis using 1 or 2 fully or partially threaded 5.5, 6.5, or 7.3 mm cannulated screws in a transverse or oblique configuration. Associated posterior ring injuries were fixed with -sacral and/or iliosacral screws. The primary outcome of interest was loss of reduction, defined as symphysis distance greater than 15 mm measured on final AP pelvis radiograph. Secondary outcomes collected by chart review were operative time, blood loss, vascular or urologic injury, sexual dysfunction, infection, implant loosening or breakage, and revision surgery.
RESULTS
Twelve patients met criteria and primary and secondary outcomes were collected. Mean clinical and radiographic follow-up were 15 months each. One patient lost reduction. Mean operative time and blood loss were 124 min and 29 cc, respectively. No vascular or urologic injuries occurred. Two patients reported sexual dysfunction. No patients became infected or required revision surgery. Four patients underwent implant removal. Seventeen additional patients were excluded due to short follow-up and limited outcomes were collected. Two of these patients lost reduction. Three underwent implant removal.
CONCLUSION
These data support percutaneous reduction and screw fixation of pubic symphysis disruption as a potentially safe and effective method of treatment that warrants further investigation.
PubMed: 35242533
DOI: 10.1016/j.jcot.2022.101806 -
Annals of Medical and Health Sciences... 2015During pregnancy, high progesterone and relaxin levels produce physiological ligament relaxation on the pelvis. Therefore, moderate pubic symphysis and sacroiliac joints...
During pregnancy, high progesterone and relaxin levels produce physiological ligament relaxation on the pelvis. Therefore, moderate pubic symphysis and sacroiliac joints relaxing provide birth canal widening, thereby facilitating vaginal delivery. Sometimes, functional pain or pelvic instability may occur during pregnancy or puerperium, which is defined as symptomatic pelvic girdle relaxation. In rare cases, a pubic symphysis disruption can occur during the labor, causing severe pain and functional limitations. The early recognition of this injury is crucial to prevent complications and improve clinical and functional outcomes. This study reports an acute symphyseal disruption resulting from childbirth in a primiparous patient who underwent open reduction and internal fixation with plate and screws. After a 6 months follow-up, the patient presented no pain and satisfactory functional recovery.
PubMed: 27057391
DOI: 10.4103/2141-9248.177980 -
Journal of Experimental Orthopaedics Sep 2020Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required....
OBJECTIVE
Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required. Until today, there is no data published how many of these procedures are performed annually and there is also no data about the outcome after this extensive surgery.
METHODS
We developed a novel surgical technique to address the arthrodesis of the pubic symphysis in a minimally invasive approach. Therefore, we used for this purpose modified instruments and performed the transplantation of a cylindrical bone substitute into the pubic symphysis, without an extensive approach or dissecting the anterior or posterior symphyseal ligaments.
RESULTS
Using this novel technique, a minimally invasive symphysiodesis was achieved in radiological findings, after the procedure.
CONCLUSION
Thus, this actually minimally invasive surgical technique seems to be a promising advancement for the arthrodesis of the pubic symphysis.
PubMed: 32940814
DOI: 10.1186/s40634-020-00284-0 -
BMJ Case Reports Sep 2019Urachal sinus usually presents with umbilical discharge and the opening can rarely be located between the umbilicus and the symphysis pubis and the so called suprapubic... (Review)
Review
Urachal sinus usually presents with umbilical discharge and the opening can rarely be located between the umbilicus and the symphysis pubis and the so called suprapubic sinus (SPS). There is another different entity of cases reported in literature with a similar presentation but with an opening anywhere between the umbilicus and symphysis pubis but differs from SPS in the pathway of the tract and the epithelial lining. We report a case of a 2-year-old boy presenting with a prepubic sinus that was managed with surgical excision. After a thorough literature review, we compare our case to other prepubic and SPS.
Topics: Child, Preschool; Cutaneous Fistula; Epithelium; Humans; Male; Pubic Symphysis; Urachus
PubMed: 31511268
DOI: 10.1136/bcr-2019-231138 -
JNMA; Journal of the Nepal Medical... Dec 2023The pubic symphysis is a midline, non-synovial joint connecting the right and left superior pubic rami. The joint allows very limited movement of approximately 0.5-1 mm....
UNLABELLED
The pubic symphysis is a midline, non-synovial joint connecting the right and left superior pubic rami. The joint allows very limited movement of approximately 0.5-1 mm. Under hormonal stimulation during pregnancy, the widening of the symphysis pubis and sacroiliac joints occurs. Pubic symphysis diastasis is defined as the widening of the pubic joint of >10 mm. It is a rare complication of vaginal childbirth for which no gold standard treatment has been defined. Most cases are treated conservatively. A case of pubic diastasis in a 24-year-old G5P2A2L1 following vaginal delivery is reported. Management consisted of simple conservative treatment, which was sufficient in achieving symptomatic relief.
KEYWORDS
case reports; pelvic pain; pubic symphysis diastasis.
Topics: Pregnancy; Female; Humans; Young Adult; Adult; Pubic Symphysis Diastasis; Pubic Symphysis; Postpartum Period; Delivery, Obstetric; Conservative Treatment
PubMed: 38289751
DOI: 10.31729/jnma.8375 -
American Journal of Obstetrics and... Jan 2022Determining fetal head descent, expressed as fetal head station and engagement is an essential part of monitoring progression in labor. Assessing fetal head station is... (Observational Study)
Observational Study
BACKGROUND
Determining fetal head descent, expressed as fetal head station and engagement is an essential part of monitoring progression in labor. Assessing fetal head station is based on the distal part of the fetal skull, whereas assessing engagement is based on the proximal part. Prerequisites for assisted vaginal birth are that the fetal head should be engaged and its lowermost part at or below the level of the ischial spines. The part of the fetal head above the pelvic inlet reflects the true descent of the largest diameter of the skull. In molded (reshaped) fetal heads, the leading bony part of the skull may be below the ischial spines while the largest diameter of the fetal skull still remains above the pelvic inlet. An attempt at assisted vaginal birth in such a situation would be associated with risks. Therefore, the vaginal or transperineal assessments of station should be supplemented with a transabdominal examination. We suggest a method for the assessment of fetal head descent with transabdominal ultrasound.
OBJECTIVE
To investigate the correlation between transabdominal and transperineal assessment of fetal head descent, and to study fetal head shape at different labor stages and head positions.
STUDY DESIGN
Women with term singleton cephalic pregnancies admitted to the labor ward for induction of labor or in spontaneous labor, at the Cairo University Hospital and Oslo University Hospital from December 2019 to December 2020 were included. Fetal head descent was assessed with transabdominal ultrasound as the suprapubic descent angle between a longitudinal line through the symphysis pubis and a line from the upper part of the symphysis pubis extending tangentially to the fetal skull. We compared measurements with transperineally assessed angle of progression and investigated interobserver agreement. We also measured the part of fetal head above and below the symphysis pubis at different labor stages.
RESULTS
The study population comprised 123 women, of whom 19 (15%) were examined before induction of labor, 8 (7%) in the latent phase, 52 (42%) in the active first stage and 44 (36%) in the second stage. The suprapubic descent angle and the angle of progression could be measured in all cases. The correlation between the transabdominal and transperineal measurements was -0.90 (95% confidence interval, -0.86 to -0.93). Interobserver agreement was examined in 30 women and the intraclass correlation coefficient was 0.98 (95% confidence interval, 0.95-0.99). The limits of agreement were from -9.5 to 7.8 degrees. The fetal head was more elongated in occiput posterior position than in non-occiput posterior positions in the second stage of labor.
CONCLUSION
We present a novel method of examining fetal head descent by assessing the proximal part of the fetal skull with transabdominal ultrasound. The correlation with transperineal ultrasound measurements was strong, especially early in labor. The fetal head was elongated in the occiput posterior position during the second stage of labor.
Topics: Adult; Female; Fetus; Head; Humans; Labor Presentation; Labor Stage, First; Labor Stage, Second; Pregnancy; Ultrasonography, Prenatal
PubMed: 34389293
DOI: 10.1016/j.ajog.2021.07.030 -
The Cochrane Database of Systematic... 2000In many settings, symphysis-fundal height measurement has replaced clinical assessment of fetal size by abdominal palpation because the latter has been reported to... (Review)
Review
BACKGROUND
In many settings, symphysis-fundal height measurement has replaced clinical assessment of fetal size by abdominal palpation because the latter has been reported to perform poorly.
OBJECTIVES
The objective of this review was to assess the effects of routine use of symphysis-fundal height measurements (tape measurement of the distance from the pubic symphysis to the uterine fundus) during antenatal care on pregnancy outcome.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trials register was searched.
SELECTION CRITERIA
Acceptably controlled trials comparing symphysis-fundal height measurement with assessment by abdominal palpation alone.
DATA COLLECTION AND ANALYSIS
One reviewer assessed trial quality and extracted data.
MAIN RESULTS
One trial involving 1639 women was included. No differences were detected in any of the outcomes measured.
REVIEWER'S CONCLUSIONS
There is not enough evidence to evaluate the use of symphysis-fundal height measurements during antenatal care.
Topics: Anthropometry; Embryonic and Fetal Development; Female; Gastric Fundus; Humans; Pregnancy; Pubic Symphysis
PubMed: 10796225
DOI: 10.1002/14651858.CD000944