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Symphysiotomy in a Nigerian hospital
International Journal of Gynecology and Obstetrics 85 (2004) 272–273
Brief communication
Symphysiotomy in a Nigerian hospital H.U. Ezegwuia,*, O.O. Olomub, E.D. Twomeyb a Federal Medical Centre, Abakaliki, Nigeria Mile Four Catholic Mission Hospital, Abakaliki, Nigeria
b
Received 18 July 2003; received in revised form 23 September 2003; accepted 24 September 2003 Keywords: Symphysiotomy; Recent experience; Nigeria
In our culture, cesarean delivery is seen as a reproductive failure w1x. The purpose of this study is to present our experience with symphysiotomy in Nigeria. The study was carried out from January 2000 through December 2001 and the data were collected from Mile Four Mission Hospital Abakaliki. Of the 4596 women who were delivered during the 2-year period, 75 (1.6%) had a symphysiotomy and 482 (10.5%) had a caesarean delivery. The mean maternal age was 25.6"3 years. The majority of the women (57.3%) were primigravidas, 37 (49.4%) had no formal education, and 57.3% were subsistence farmers. Among the 75 women who had a symphysiotomy, six (8%) had a previous cesarean section and three (4%) had a previous symphysiotomy. The indications for a symphysiotomy were cephalopelvic disproportion in 65 (86.6%) of the women and to deliver the fetal head in eight cases of breech presentation (10.7%). Two women had a spontaneous symphysiotomy. Only 11 (14.6%) of the women experienced complications. Paraurethral lacerations in four women *Corresponding author. Present address: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu State, P M B 01129 Enugu, Nigeria Tel.: q 234-4-6119474. E-mail address: [email protected] (H.U. Ezegwui).
and transient stress incontinence, also in four women (36.4% each) were the most common complications, followed by wound infection (18.2%) and hemorrhage (9.0%). Most women (92.9%) were able to walk on discharge and all were able to walk and run at follow-up. A majority of women (45 w60%x) stayed in the hospital between 6 and 10 days, while 15 (20%) stayed between 1 and 5 days and 6 (4%) stayed between 21 and 30 days. The lowest birth weight was between 2.0 and 2.5 kg (1 w1.3%x), the highest birth weights ranged between 4.4 and 4.9 kg (6 w8.0%x), and there were six neonatal deaths. The women were usually catheterized for only 2 days unless there were complications, which were minimal and responded readily to treatment. The two cases of wound infection resulted from the neglect of an infected obstructed labor and transient stress incontinence was due to the urethral catheter, which weakened the urethral support (the fibrous tissue usually fills the ‘gap’ created by symphysiotomy and stress is never a permanent feature). Most of the women had no difficulty walking on discharge and at follow-up. We performed symphysiotomy using the simplified Zarate procedure w2x, which explains the minimal complications experienced. Perinatal death was due to prolonged
0020-7292/04/$30.00 䊚 2003 International Society of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2003.09.017
H.U. Ezegwui et al. / International Journal of Gynecology and Obstetrics 85 (2004) 272–273
obstructed labor and not to the procedure. There was no maternal death. In conclusion, women in obstructed labour should be offered the options of cesarean delivery and symphysiotomy. Practitioners who have mastered the symphysiotomy procedure should be encouraged to pass on this skill and keep the procedure in use.
273
References w1x Cox LM. Symphysiotomy in Nigeria. J Obstet Gynaecol Br Commonw 1966;73:237 –243. w2x Zarate E. Subcutaneous partial symphysiotomy. Gynecol Obstet 1926;14:289.
Brief communication
Symphysiotomy in a Nigerian hospital H.U. Ezegwuia,*, O.O. Olomub, E.D. Twomeyb a Federal Medical Centre, Abakaliki, Nigeria Mile Four Catholic Mission Hospital, Abakaliki, Nigeria
b
Received 18 July 2003; received in revised form 23 September 2003; accepted 24 September 2003 Keywords: Symphysiotomy; Recent experience; Nigeria
In our culture, cesarean delivery is seen as a reproductive failure w1x. The purpose of this study is to present our experience with symphysiotomy in Nigeria. The study was carried out from January 2000 through December 2001 and the data were collected from Mile Four Mission Hospital Abakaliki. Of the 4596 women who were delivered during the 2-year period, 75 (1.6%) had a symphysiotomy and 482 (10.5%) had a caesarean delivery. The mean maternal age was 25.6"3 years. The majority of the women (57.3%) were primigravidas, 37 (49.4%) had no formal education, and 57.3% were subsistence farmers. Among the 75 women who had a symphysiotomy, six (8%) had a previous cesarean section and three (4%) had a previous symphysiotomy. The indications for a symphysiotomy were cephalopelvic disproportion in 65 (86.6%) of the women and to deliver the fetal head in eight cases of breech presentation (10.7%). Two women had a spontaneous symphysiotomy. Only 11 (14.6%) of the women experienced complications. Paraurethral lacerations in four women *Corresponding author. Present address: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu State, P M B 01129 Enugu, Nigeria Tel.: q 234-4-6119474. E-mail address: [email protected] (H.U. Ezegwui).
and transient stress incontinence, also in four women (36.4% each) were the most common complications, followed by wound infection (18.2%) and hemorrhage (9.0%). Most women (92.9%) were able to walk on discharge and all were able to walk and run at follow-up. A majority of women (45 w60%x) stayed in the hospital between 6 and 10 days, while 15 (20%) stayed between 1 and 5 days and 6 (4%) stayed between 21 and 30 days. The lowest birth weight was between 2.0 and 2.5 kg (1 w1.3%x), the highest birth weights ranged between 4.4 and 4.9 kg (6 w8.0%x), and there were six neonatal deaths. The women were usually catheterized for only 2 days unless there were complications, which were minimal and responded readily to treatment. The two cases of wound infection resulted from the neglect of an infected obstructed labor and transient stress incontinence was due to the urethral catheter, which weakened the urethral support (the fibrous tissue usually fills the ‘gap’ created by symphysiotomy and stress is never a permanent feature). Most of the women had no difficulty walking on discharge and at follow-up. We performed symphysiotomy using the simplified Zarate procedure w2x, which explains the minimal complications experienced. Perinatal death was due to prolonged
0020-7292/04/$30.00 䊚 2003 International Society of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2003.09.017
H.U. Ezegwui et al. / International Journal of Gynecology and Obstetrics 85 (2004) 272–273
obstructed labor and not to the procedure. There was no maternal death. In conclusion, women in obstructed labour should be offered the options of cesarean delivery and symphysiotomy. Practitioners who have mastered the symphysiotomy procedure should be encouraged to pass on this skill and keep the procedure in use.
273
References w1x Cox LM. Symphysiotomy in Nigeria. J Obstet Gynaecol Br Commonw 1966;73:237 –243. w2x Zarate E. Subcutaneous partial symphysiotomy. Gynecol Obstet 1926;14:289.