Re: Spontaneous rupture of symphysis pubis
From: Joe (forcep@intercom.net)
Fri Apr 25 23:00:08 2008
Amazing! Thanks for sharing. Joe C
Raymond Stephen wrote:
> 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
>>quality of the after care. I personally have never seen a case of any
>>disability after a symphysiotomy and I have done a few!
>>
>>Steve
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>Bernard Cristalli
>>Sent: Friday, 25 April 2008 4:27 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Spontaneous rupture of symphysis pubis
>>
>>With severe disability afterwards.
>>Bernard
>>
>>> >
>>> > Andrew: What was reasoning used to justify putting a plate in
>>> for the
>>> > separation? In the past in some areas of world cutting the
>>> symphysis was
>>> > practiced to allow obstructed birth to proceed. Joe C
>>> >
>>>
>>
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