[An alternative to cesarean section: symphysiotomy (Zarate's operation)]

Area of Science:

• Obstetrics and Gynecology
• Surgical Procedures
• Maternal-Fetal Medicine

Context:

• Difficult vaginal deliveries due to cephalic presentation impacted at the interspinous or inferior pelvic strait.
• Limited access to cesarean sections in developing countries.
• Need for interventions to prevent maternal and fetal trauma during obstructed labor.

Purpose:

• To describe the technique and indications for Zarate's operation (non-total subcutaneous symphysiotomy).
• To highlight its utility in facilitating vaginal delivery in cases of pelvic dystocia.
• To evaluate its role in reducing cesarean delivery rates and associated complications.

Summary:

• Zarate's operation is a symphysiotomy technique that widens the pelvis to allow vaginal delivery of a cephalic presentation.
• It is particularly beneficial in developing countries where cesarean sections may be less accessible or riskier.
• The procedure is technically straightforward, preserves uterine integrity, and avoids instrumental extraction trauma.

Impact:

• Reduces the incidence of cesarean sections and associated maternal/fetal trauma.
• Lowers the occurrence of severe obstetric complications like vesico-vaginal fistula and hysterorrhexis.
• Offers a viable alternative to cesarean delivery, though associated with a longer and potentially more disabling post-operative recovery.