{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:19:00Z","timestamp":1779891540194,"version":"3.53.1"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,4,29]],"date-time":"2016-04-29T00:00:00Z","timestamp":1461888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Ammalife","award":["1120236"],"award-info":[{"award-number":["1120236"]}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Obstructed labour is a major cause of maternal mortality. Caesarean section can be associated with risks, particularly in low\u2010 and middle\u2010income 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare symphysiotomy and caesarean section for obstructed labour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> EMBASE<\/jats:styled-content>, Cochrane library, <jats:styled-content style=\"fixed-case\">CINAHL<\/jats:styled-content>, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>Studies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>Quality of the included studies was assessed using the <jats:styled-content style=\"fixed-case\">STROBE<\/jats:styled-content> checklist and the Newcastle Ottawa scale. Relative risks (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) were pooled using the random effects model. Heterogeneity was assessed using <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Seven studies (<jats:italic>n<\/jats:italic> = 1266 women), all of which were set in low\u2010 and middle\u2010income countries (as per the World Bank definition) and compared symphysiotomy and caesarean section were identified. Meta\u2010analyses showed no significant difference in maternal (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.48, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.13\u20131.76; <jats:italic>P<\/jats:italic> = 0.27) or perinatal (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.12, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.64\u20131.96; <jats:italic>P<\/jats:italic> = 0.69) mortality with symphysiotomy when compared with caesarean section. There was a reduction in infection (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.30, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.14\u20130.62) but an increase in fistulae (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 4.19, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.07\u201316.39) and stress incontinence with symphysiotomy (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 10.04, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 3.23\u201331.21).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Symphysiotomy could be an alternative to caesarean section when resources are limited.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14040","type":"journal-article","created":{"date-parts":[[2016,4,30]],"date-time":"2016-04-30T13:36:17Z","timestamp":1462023377000},"page":"1453-1461","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Symphysiotomy for obstructed labour: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"123","author":[{"given":"A","family":"Wilson","sequence":"first","affiliation":[{"name":"Institute of Metabolism and Systems Research University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EG","family":"Truchanowicz","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Sciences Institute for Biomedical Research College of Medical &amp; Dental Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Elmoghazy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Minia University Minia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"MacArthur","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research College of Medical &amp; Dental Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Coomarasamy","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,4,29]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"WHO Statement on Caesarean Section Rates","author":"World Health Organization","year":"2015"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06414-5"},{"key":"e_1_2_6_4_1","unstructured":"UNICEF.Maternal mortality.2009[www.unicef.org\/specialsession\/about\/sgreportpdf09_MaternalMortality_D7341Insert_English.pdf]. 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