Symphysiotomy could dramatically reduce maternal deaths

Teaching doctors in Africa a low-tech operation to cut the cartilage of the symphysis pubis could save the lives of women in obstructed labor and their babies, according to an Essay in the open access journal PLoS Medicine.

The symphysis pubis is where the pubic bones meet at the front of the pelvis. The operation, called symphysiotomy, which is done under local anaesthetic, increases the size of the pelvic outlet and permits vaginal delivery of the baby. The operation takes just 2-3 minutes and is usually carried out in the labor ward, not the operating theater.

Dr Douwe Arie Anne Verkuyl (Department of Obstetrics and Gynecology, Bethesda Hospital, Hoogeveen, The Netherlands), author of the Essay, says that in many African hospitals symphysiotomies are no longer performed. This is because, she says, "doctors believe that, since developed countries can do without them and still achieve excellent obstetric outcomes, this operation is obsolete and Africa will soon "catch up"."

Unlike the rich world, however, one of the most common causes of maternal death in low income countries is obstructed labor. The availability of relatively low-tech symphysiotomies, says the author, would help to address this dire situation.