Symphysiotomy for obstructed labour: a systematic review and meta-analysis

Area of Science:

• Obstetrics and Gynecology
• Global Health
• Surgical Procedures

Background:

• Obstructed labour is a significant contributor to maternal mortality globally.
• Caesarean section, while effective, poses risks and accessibility challenges in low- and middle-income countries (LMICs).
• Symphysiotomy presents a less resource-intensive alternative, but its safety and efficacy require thorough evaluation.

Purpose of the Study:

• To conduct a systematic review and meta-analysis comparing symphysiotomy and caesarean section for managing obstructed labour.
• To evaluate maternal and perinatal mortality as primary outcomes.
• To assess secondary outcomes including infection, fistulae, and incontinence.

Main Methods:

• A comprehensive literature search was performed across multiple databases (MEDLINE, EMBASE, Cochrane Library, etc.) up to November 2015.
• Seven studies involving 1266 women, all conducted in LMICs, were included in the meta-analysis.
• Study quality was assessed using STROBE and Newcastle Ottawa scales, with relative risks pooled using a random effects model.

Main Results:

• No statistically significant differences were observed in maternal mortality (RR 0.48, 95% CI 0.13-1.76) or perinatal mortality (RR 1.12, 95% CI 0.64-1.96) between symphysiotomy and caesarean section.
• Symphysiotomy was associated with a significant reduction in infection rates (RR 0.30, 95% CI 0.14-0.62).
• However, symphysiotomy increased the risk of fistulae (RR 4.19, 95% CI 1.07-16.39) and stress incontinence (RR 10.04, 95% CI 3.23-31.21).

Conclusions:

• Symphysiotomy and caesarean section yield comparable outcomes regarding maternal and perinatal mortality in cases of obstructed labour.
• Symphysiotomy can be considered a feasible alternative to caesarean section in settings with limited resources.
• Healthcare providers should weigh the benefits of reduced infection against the increased risks of fistulae and incontinence when considering symphysiotomy.