• A Wilson, E G Truchanowicz, D Elmoghazy, C MacArthur, and A Coomarasamy.
• Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
• BJOG. 2016 Aug 1; 123 (9): 1453-61.

BackgroundObstructed labour is a major cause of maternal mortality. Caesarean section can be associated with risks, particularly in low- and middle-income countries, where it is not always readily available. Symphysiotomy can be an alternative treatment for obstructed labour and requires fewer resources. However, there is uncertainty about the safety and effectiveness of this procedure.ObjectivesTo compare symphysiotomy and caesarean section for obstructed labour.Search StrategyMEDLINE, EMBASE, Cochrane library, CINAHL, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction.Selection CriteriaStudies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes.Data Collection And AnalysisQuality of the included studies was assessed using the STROBE checklist and the Newcastle Ottawa scale. Relative risks (RR) were pooled using the random effects model. Heterogeneity was assessed using I(2) tests.Main ResultsSeven studies (n = 1266 women), all of which were set in low- and middle-income countries (as per the World Bank definition) and compared symphysiotomy and caesarean section were identified. Meta-analyses showed no significant difference in maternal (RR 0.48, 95% CI 0.13-1.76; P = 0.27) or perinatal (RR 1.12, 95% CI 0.64-1.96; P = 0.69) mortality with symphysiotomy when compared with caesarean section. There was a reduction in infection (RR 0.30, 95% CI 0.14-0.62) but an increase in fistulae (RR 4.19, 95% CI 1.07-16.39) and stress incontinence with symphysiotomy (RR 10.04, 95% CI 3.23-31.21).ConclusionThere was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section.Tweetable AbstractSymphysiotomy could be an alternative to caesarean section when resources are limited.© 2016 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

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