title: Symphysiotomy for obstructed labour: a systematic review and meta-analysis.
abstract: BACKGROUND
  Obstructed 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.
  
  
  OBJECTIVE
  To compare symphysiotomy and caesarean section for obstructed labour.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane library, CINAHL, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction.
  
  
  METHODS
  Studies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes.
  
  
  METHODS
  Quality 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.
  
  
  RESULTS
  Seven 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).
  
  
  CONCLUSIONS
  There was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section.
  
  
  CONCLUSIONS
  Symphysiotomy could be an alternative to caesarean section when resources are limited.
authors.affiliation: Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Centre for Cardiovascular Sciences, Institute for Biomedical Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: E G
authors.initials: EG
authors.lastname: Truchanowicz
authors.affiliation: Faculty of Medicine, Minia University, Minia, Egypt.
authors.forename: D
authors.initials: D
authors.lastname: Elmoghazy
authors.affiliation: Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: MacArthur
authors.affiliation: Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Coomarasamy
mesh_terms: D002585:Cesarean Section / Q000379:methods*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000601:surgery*; D054238:Perinatal Mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology; D013567:Symphysiotomy / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000453:epidemiology
keywords: Caesarean section; low- and middle-income countries; obstructed labour; symphysiotomy