Symphysiotony for mild cephalopelvic disproportion

Abstract

The operation of symphysiotomy was first performed by Claude-De La Corvee in 1655 on a recently dead patient (Munro Kerr and Chassar Moir 1956). Signault (quoted by Greig 1964) performed the first modern operation in 1777 on a patient who had a true conjugate of 6.5cms., and who had had 4 previous stillbirths. He obtained a live healthy baby but the mother unfortunately suffered from a urinary fistula for the rest of her life. For the next hundred and fifty years the operation enjoyed several brief periods of popularity in Europe, but because it was performed on patients with gross pelvic contraction the inevitable urinary complications of damage to the bladder, urethra and vestibule followed.The incidence of haemorrhage and sepsis was also very high, and the operation never gained general acceptance. In 1931 Zarate (1955) revived the operation with his technique of subcutaneous, partial or intracapsular symphysiotomy. Subsequently, Spain (1949) and Barry (1950, 1952) further popularized the operation in Ireland with their open technique. Barry (1950) declared that symphysiotomy offers a cure for disproportion, not a treatment.. Crichton and Seedat (1963) exhaustively evaluated the operation as a method of managing cases of mild cephalo-pelvic disproportion and reported on 1,200 cases with excellent results.