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Re: Spontaneous rupture of symphysis pubisFrom: Raymond Stephen (Stephen.Raymond@dhhs.tas.gov.au)Fri Apr 25 18:53:22 2008
Catheterise the bladder. Local anaesthetic is injected over the symphysis; insert index finger of left hand into vagina in order to deviate the urethra (containing catheter) to one side of midline. Keep index finger in the indentation between the two pubic rami. Two assistants should hold the abducted and flexed knees of the patient. Introduce knife vertically into the symphysis and using a stroking, rocking motion divide the (quite tough) fibres of the symphyseal body until you can just feel the tip of the knife with your left finger about to cut the last of the fibres. Ensure that you haven't only cut anterior fibres but also those at the superior and inferior surface. The assistants then allow further abduction of hips until the final (posterior) fibres are felt to give way. The finger will then be felt to enter a space between the two bones, which is usually about 10 - 15 mm wide. The knees should be supported and prevented from further abduction until after the baby is born, which is usually rapidly after this. After managing the third and fourth stages bind the knees together and, if felt necessary, put a binder around the trochanters and do not remove either binder for a minimum of 72 hours. Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joe Sent: Friday, 25 April 2008 9:50 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Spontaneous rupture of symphysis pubis Steve . my man! Could you describe how it is done? Interesting. Joe C Raymond Stephen wrote:
> The incidence of disability after a symphysiotomy is related to the CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose.
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