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de Groot MA, Brunner EL, Kolk A, Duindam M. Postpartum pubic symphysis diastasis resulting in a prepubic abscess and osteomyelitis. BMJ Case Rep 2023; 16:e256390. [PMID: 37989325 PMCID: PMC10668185 DOI: 10.1136/bcr-2023-256390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Postpartum pubic symphysis diastasis (PSD) refers to an abnormal widening of the pubic symphysis after delivery. It is a rare and underdiagnosed condition that causes severe pain and can be complicated by osteomyelitis and abscess formation. This article reports a case of a para 4 woman in her 30s with postpartum PSD after vaginal delivery who presented with a prepubic abscess. Multimodal treatment consisted of incision and drainage, physiotherapy and prolonged antibiotic treatment.
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Affiliation(s)
| | | | - Arjen Kolk
- Orthopedic Surgery, HagaZiekenhuis, Den Haag, Netherlands
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Muacevic A, Adler JR. Postpartum Pelvic Instability: A Case Report. Cureus 2023; 15:e33707. [PMID: 36788881 PMCID: PMC9922089 DOI: 10.7759/cureus.33707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
Pubic symphysis diastasis following childbirth is a rare orthopedic condition that can be debilitating in the postpartum period. There have been treatment options documented, ranging from conservative to surgical; however, no standard of care has been established. We present a 44-year-old female patient who underwent open reduction and internal fixation for continued instability from postpartum pubic symphysis diastasis with a good overall outcome. We demonstrate good outcomes in a patient treated with surgical fixation of postpartum pelvic diastasis. We hope to deliver insight to future orthopedic surgeons with the challenges in treating this condition.
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Gupta A, Durairaj J, Gadipudi A, Pampapati V, Nayak D. Clinical Presentation and Management of Peripartum Pubic Diastasis. J Obstet Gynaecol India 2022; 72:146-151. [PMID: 35928090 PMCID: PMC9343551 DOI: 10.1007/s13224-021-01590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Symphysis pubis diastasis (SPD) is an uncommon peripartum complication which can have short-term morbidities secondary to pain and restricted movements as well as long-term complications. It is important to diagnose this condition as it causes significant discomfort to the nursing mothers. We present our experience in five patients with SPD who were managed successfully. Methods Present study is an observation of five cases of SPD managed in a single unit in a tertiary care center over three years from January 2017 to December 2019. All women with symptoms of SPD with inter-pubic distance of more than 10 mm were selected for the study. The demographic profile, clinical details, diagnostic imaging findings, and treatment provided for such patients were noted down from the individual case records. Follow-up of each patient for improvement in the symptoms and X-ray findings was available till 3 months for each case. Results Mean age of the women with SPD was 29.8 ± 5.4 years. Four women had vaginal delivery and one had vacuum delivery. Average birth weight is 3.26 ± 0.85 kg. Mean duration of first stage of labor is 6.6 ± 0.89 h and median of second stage is 35 min. Average inter-pubic distance at the time of diagnosis on X-ray was 1.84 ± 0.2 cm. All women were managed conservatively with bed rest, analgesics, pelvic binder and physiotherapy. Improvement in the range of movement was noted over average of 21.8 ± 3.7 days and symptoms resolved over 14.4 ± 2.6 weeks. Conclusion Treating obstetrician should be aware of this condition as simple treatment measures can avoid the long-term morbidities and complications.
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Heim JA, Vang S, Lips E, Asche SE, Ly T, Das K. Pubic Symphysis Separation and Regression in Vaginal versus Cesarean Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:42-47. [PMID: 34416357 DOI: 10.1016/j.jogc.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To quantify the association of pubic symphysis separation with mode of delivery and follow the resolution of this physiologic separation in the postpartum period. METHODS Prospective observational cohort study that recruited two cohorts of primiparous women: those undergoing vaginal and cesarean delivery (45 and 46 patients, respectively). Chart review collected intrapartum factors. Patients were followed with serial anterior-posterior radiographs within 48 hours of delivery and at 6, 12, and 24 weeks postpartum, to evaluate the extent of pubic symphysis separation. Differences between the two cohorts in intrapartum factors were assesses as was pubic symphysis separation at each time point. RESULTS Mean age of women was 25.8 (SD 5.1) years, and 56% were White. Mean birth weight was 3.5 (SD 0.52) kg. Mean immediate postpartum pubic symphysis separation was 7.6 (SD 2.2) mm and did not differ between groups, at 7.18 mm for vaginal delivery versus 8.04 mm for cesarean delivery (CD; P = 0.08). Pubic symphysis separation was not significantly different for CD with and without labour. Black race and obesity were associated with increased pubic symphysis separation. No intrapartum events were related to extent of separation. Normalization of pregnancy pubic symphysis separation to 4-5 mm occurred by 6 weeks postpartum. Separation of >10mm and <15mm occurred in 10 of the 91 women and occurred after vaginal and cesarean delivery. The widest pubic symphysis separation was observed in 3 patients after vaginal delivery. CONCLUSION Physiological pubic symphysis separation occurs during pregnancy and regresses postpartum with minimal effects from labour and delivery. Cesarean delivery does not prevent physiological pubic symphysis separation.
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Affiliation(s)
- Jennifer A Heim
- Department of Obstetrics & Gynecology, Kaiser Permanente (TPMG), Santa Clara, CA
| | - Sandy Vang
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Erin Lips
- Department of Obstetrics & Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | | | - Thuan Ly
- Department of Orthopaedic Trauma, Massachusetts General Hospital, Boston, MA
| | - Kamalini Das
- Department of Obstetrics, Gynecology and Women's Health, Regions Hospital, St. Paul, MN.
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Pascarella R, Sangiovanni P, Fantasia R, Cerbasi S. Chronic Pelvic Diastasis 22 Years After Twin Natural Delivery: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00107. [PMID: 34111042 DOI: 10.2106/jbjs.cc.20.00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present here a case of chronic pelvic separation 22 years after twin natural delivery in a 49-year-old woman surgically treated with anterior and posterior stabilization. The functional and radiological recovery after a 4-year follow-up was extremely good. CONCLUSION Postpartum pubic symphysis diastasis is a rare but dreaded complication of natural delivery. Nonoperative treatment is still considered the gold standard. However, when pain persists despite nonoperative treatment and when a pelvic radiograph reveals a pubic diastasis greater than 2 cm, surgery is recommended. In the case of low back pain because of sacroiliac joint lesions, posterior fixation is indicated.
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Peripartum Pubic Symphysis Diastasis-Practical Guidelines. J Clin Med 2021; 10:jcm10112443. [PMID: 34072828 PMCID: PMC8198205 DOI: 10.3390/jcm10112443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022] Open
Abstract
Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications.
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Sung JH, Kang M, Lim SJ, Choi SJ, Oh SY, Roh CR. A case-control study of clinical characteristics and risk factors of symptomatic postpartum pubic symphysis diastasis. Sci Rep 2021; 11:3289. [PMID: 33558543 PMCID: PMC7870961 DOI: 10.1038/s41598-021-82835-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/25/2021] [Indexed: 01/27/2023] Open
Abstract
Postpartum pubic symphysis diastasis (PPSD) refers to the separation of pubic symphysis after delivery. It is typically diagnosed based on clinical symptoms and radiologic findings. This study tried to assess clinical characteristics and risk factors of PPSD. This was a nested case-control study matched for year of delivery and gestational age at delivery using a retrospective cohort of women who delivered vaginally at a single institution. The incidence of PPSD was 0.156% (33/21,131). The incidence rate increased from 0.08% (7/9328) in 2000-2004 to 0.13% (9/7138) in 2005-2009 and to 0.36% (17/4665) in 2010-2016, simultaneously with an increase of maternal age (30.7 ± 3.5 years in 2000-2004 to 31.8 ± 3.8 years in 2005-2009 and 32.8 ± 3.8 years in 2010-2016). Nulliparity was associated with a higher incidence of PPSD (81.8% in cases vs. 57.6% in controls, p = 0.01). Other factors including pre-pregnancy body mass index, weight gain during pregnancy, gestational diabetes, induction of labor, duration of labor, epidural anesthesia, vacuum-assisted delivery, episiotomy, neonatal sex and birth weight failed to show difference between the two groups. In short, the incidence of PPSD increased with time along with an increase of maternal age. Nulliparity was the only significant risk factor for PPSD.
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Affiliation(s)
- Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Mina Kang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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Wang Y, Li YQ, Tian MR, Wang N, Zheng ZC. Role of relaxin in diastasis of the pubic symphysis peripartum. World J Clin Cases 2021; 9:91-101. [PMID: 33511175 PMCID: PMC7809669 DOI: 10.12998/wjcc.v9.i1.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/10/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Separation of the pubic symphysis can occur during the peripartum period. Relaxin (RLX) is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments. However, it is unknown whether RLX is associated with peripartum pubic symphysis separation and if the association is affected by other factors.
AIM To study the association between RLX and peripartum pubic symphysis separation and evaluate other factors that might affect this association.
METHODS We performed a cross-sectional study of pregnant women between April 2019 and January 2020. Baseline demographic characteristics, including gestational age, weight, neonatal weight, delivery mode and duration of the first and second stages of labor, were recorded. The clinical symptoms were used as a screening index during pregnancy, and the patients with pubic symphysis and inguinal pain were examined by color Doppler ultrasonography to determine whether there was pubic symphysis separation. Serum RLX concentrations were evaluated 1 d after delivery using an enzyme-linked immunosorbent assay, and pubic symphysis separation was diagnosed based on postpartum X-ray examination. We used an independent-sample t test to analyze the association between serum RLX levels and peripartum pubic symphysis separation. Multivariate regression analysis was used to evaluate whether the association between RLX and peripartum pubic symphysis separation was confounded by other factors, and the association between RLX and the severity of pubic symphysis separation was also assessed. We used Pearson correlation analysis to determine the factors related to RLX levels as well as the correlation between the degree of pubic symphysis separation and activities of daily living (ADL) and pain.
RESULTS A total of 54 women were enrolled in the study, with 15 exhibiting (observational group) and 39 not exhibiting (control group) peripartum pubic symphysis separation. There were no statistically significant differences in terms of maternal age, gestational age, pre-pregnancy weight, weight gain during pregnancy, delivery modes, or duration of the first or second stages of labor between the 2 groups. We did, however, note a statistically significant difference in serum RLX concentrations and neonatal weight between the observational and control groups (122.3 ± 0.7 µg/mL vs 170.4 ± 42.3 µg/mL, P < 0.05; 3676.000 ± 521.725 g vs 3379.487 ± 402.420 g, P < 0.05, respectively). Multivariate regression analyses showed that serum RLX level [odds ratio (OR): 1.022) and neonatal weight (OR: 1.002) were associated with pubic symphysis separation peripartum. The degree of separation of the pubic symphysis was negatively correlated with ADL and positively correlated with pain. There was no statistically significant association between serum RLX levels and the severity of pubic symphysis separation after adjusting for confounding factors.
CONCLUSION Serum RLX levels and neonatal weight were associated with the occurrence, but not the severity, of peripartum pubic symphysis separation.
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Affiliation(s)
- Yan Wang
- Rehabilitation Medicine, Taian City Central Hospital, Taian 271000, Shandong Province, China
| | - Yong-Qiang Li
- Department of Otolaryngology, Taian City Central Hospital, Taian 271000, Shandong Province, China
| | - Mei-Rong Tian
- Department of Obstetrics, Taian City Central Hospital, Taian 271000, Shandong Province, China
| | - Nan Wang
- Rehabilitation Centre, Qingdao Fuwai Cardiovascular Hospital, Qingdao 266034, Shandong Province, China
| | - Zun-Cheng Zheng
- Department of Rehabilitation, Taian City Central Hospital, Taian 271000, Shandong Province, China
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Choo HJ, Hwang SK, Hynes CK. Musculoskeletal Issues and Care for Pregnant and Postpartum Women. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Cain U, Gaetke-Udager K, Siegal D, Yablon CM. Musculoskeletal Injuries in Pregnancy. Semin Roentgenol 2020; 56:79-89. [PMID: 33422186 DOI: 10.1053/j.ro.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Usa Cain
- Musculoskeletal Imaging Fellow, University of Michigan, Ann Arbor, MI
| | | | - Daniel Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, MI
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Norvilaite K, Kezeviciute M, Ramasauskaite D, Arlauskiene A, Bartkeviciene D, Uvarovas V. Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature. World J Clin Cases 2020; 8:110-119. [PMID: 31970176 PMCID: PMC6962077 DOI: 10.12998/wjcc.v8.i1.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy. As it is a rare pathology (ranging from 1 in 300 to 1 in 30000 pregnancies), no gold standard treatment has been defined.
CASE SUMMARY This study examines two cases, a 27-year-old woman (gravida 1, para 1) and a 32-year-old woman (gravida 2, para 2), who presented to the clinic after uneventful vaginal deliveries. A normal pregnancy with no complications was observed in both patients. Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion. Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended. Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations. The symptoms decreased after treatment. Post-treatment magnetic resonance imaging (MRI) in the first case showed a reduction in symphyseal separation with no signs of osteitis. Three years later the symptoms recurred; MRI examination showed no further symphyseal widening or signs of osteitis. A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery. In the second case, pain recurred when the patient conceived for the second time. This time no benefit following conservative treatment was observed. Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy, thus surgical treatment was chosen and internal pubic synthesis was performed.
CONCLUSION Overall, surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.
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Affiliation(s)
- Kristina Norvilaite
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania
| | - Monika Kezeviciute
- Vilnius University, Institute of Clinical Medicine, Faculty of Medicine, Vilnius LT-08661, Lithuania
| | - Diana Ramasauskaite
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania
| | - Audrone Arlauskiene
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania
| | - Daiva Bartkeviciene
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania
| | - Valentinas Uvarovas
- Department of Orthopedics and Traumatology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania
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Traumatic Pelvic Ring Injury following Childbirth with Complete Pubic Symphysis Diastasis. Case Rep Orthop 2019; 2019:1785167. [PMID: 31827958 PMCID: PMC6881751 DOI: 10.1155/2019/1785167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/08/2019] [Indexed: 11/18/2022] Open
Abstract
Case Traumatic pelvic ring injury following childbirth is a rare but debilitating condition. We present a case of a 28-year-old female who sustained a traumatic pelvic ring injury following childbirth with a complete pubic symphysis separation of 5.6 cm treated successfully with nonoperative management. Conclusion Operative and nonoperative treatments for traumatic pelvic ring injuries following childbirth have been described without universal adoption of a uniform treatment modality. We hope this case study adds to the collection of data to help guide medical decision-making in the future as surgeons encounter patients with similar orthopedic injuries.
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Rondón Tapia M, Reyna Villasmil E, Vargas García A. Separación de la sínfisis púbica postparto. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La separación de la sínfisis púbica después del parto vaginal normal es rara. La etiología no es clara y se asocia con multiparidad, macrosomía, debilitamiento fisiológico de la articulación y fuerza excesiva en el área púbica. Los síntomas incluyen dolor cerca de la articulación púbica, caderas, ingle, región inferior del abdomen y parte interna de los muslos, acompañado de sensibilidad del área. Los estudios con imágenes muestran la distancia entre los huesos púbicos. El manejo médico es variable y los resultados potenciales todavía son poco comprendidos. El retraso en el diagnóstico tiene graves consecuencias para la salud de la mujer en forma aguda y a largo plazo. Se presenta una paciente de 18 años con dolor lacerante en el área púbica durante el segundo día del puerperio. Tenía antecedentes de embarazo de evolución normal y parto vaginal espontáneo, a término, con recién nacido vivo y sin complicaciones. En el examen físico había dolor moderado en la región del pubis que interfería con la marcha y los movimientos activos de ambos miembros inferiores. La radiografía pélvica anteroposterior en posición supina mostró separación anormal de la sínfisis púbica de aproximadamente 25 milímetros de extensión, sin otras anomalías óseas o congénitas. Se recomendó tratamiento conservador con recuperación a los 3 meses.
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Chawla JJ, Arora D, Sandhu N, Jain M, Kumari A. Pubic Symphysis Diastasis: A Case Series and Literature Review. Oman Med J 2017; 32:510-514. [PMID: 29218129 DOI: 10.5001/omj.2017.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Separation of pubic symphysis during delivery is a rare complication resulting in considerable and prolonged morbidity for parturient women. The usual presentation is that of something giving way in the region of the symphysis pubis sometimes with an audible crack at the time of delivery. Unbearable pain on moving from side-to-side and on performing any weight-bearing activity (such as walking or climbing stairs) precludes ambulation in the immediate postpartum period. This could be accompanied by disruption of the sacroiliac joint, hemorrhage, or urine incontinence in severe cases. Radiography, ultrasound, and magnetic resonance imaging are the diagnostic modalities that aid confirmation of diagnosis. The magnitude of separation does not correlate well with the severity of symptoms. Treatment modalities range from conservative management (including analgesics, pelvic binders, transcutaneous nerve stimulation) and chiropractic management to orthopedic interventions such as external fixation or open reduction and internal fixation. Since postpartum pain is frequently dismissed as attributable to labor and childbirth, the diagnosis of pubic symphysis diastasis is often delayed and sometimes missed altogether. Since there is no consensus in the scientific literature on the definition, etiopathogenesis, and management of this rare complication, we attempted to review the literature on the subject and present a series of two cases.
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Affiliation(s)
- Jaya Jethra Chawla
- Department of Obstetrics and Gynaecology, PGIMER, DR RML Hospital, New Delhi, India
| | - Devendra Arora
- Department of Obstetrics and Gynaecology, Command Hospital, Pune, India
| | - Namrita Sandhu
- Department of Obstetrics and Gynaecology, Army College of Medical Sciences and Base Hospital, New Delhi, India
| | - Megha Jain
- Department of Radiodiagnosis and Imaging, Army College of Medical Sciences and Base Hospital, New Delhi, India
| | - Anju Kumari
- Department of Anaesthesiology and Critical Care, VMCC and Safdarjung Hospital, New Delhi, India
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Buitendyk M, Brennan B, Vora P, Smith P, Winsor S. Acute Intrapartum Rupture of the Pubic Symphysis Requiring Resuscitation and Surgical Intervention: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:68-71. [PMID: 28822629 DOI: 10.1016/j.jogc.2017.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pubic symphysis rupture significant enough to cause serious complications or require surgical intervention is exceedingly rare. Here we review the literature and examine the details of a unique presentation. CASE A 27-year-old woman presented in labour at 34+6 weeks gestation after an uncomplicated monochorionic-diamniotic twin pregnancy. After vaginal delivery, she developed a substantial labial hematoma. Hours later, she became hemodynamically unstable. Imaging revealed a 4.7-cm pubic diastasis and a small arterial tear. One week later, the diastasis had expanded to 6 cm on X-ray. As a result, the patient underwent surgical intervention. She was discharged home on postpartum day 21 and remained non-weight-bearing for 8 weeks. CONCLUSION Pubic symphysis rupture is a potentially life-threatening obstetrical complication that requires early recognition and effective multidisciplinary care.
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Affiliation(s)
- Marie Buitendyk
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON.
| | - Barbara Brennan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, ON
| | - Parag Vora
- Department of Radiology, McMaster University Medical Centre, Hamilton, ON
| | - Patricia Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, ON
| | - Stephanie Winsor
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University Medical Centre, Hamilton, ON
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Sujana B, Keepanasseril A, Maurya DK. Diastasis of the pubic symphysis following vaginal delivery. Int J Gynaecol Obstet 2017. [PMID: 28632916 DOI: 10.1002/ijgo.12242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bhumireddy Sujana
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Dilip K Maurya
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Bombaci H. Outcome of Internal Fixation and Corticocancellous Grafting of Symphysis Pubis Diastasis Which Developed after Malunion of Pubic Rami Fracture. Hip Pelvis 2017; 29:150-153. [PMID: 28611968 PMCID: PMC5465398 DOI: 10.5371/hp.2017.29.2.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/09/2017] [Accepted: 03/21/2017] [Indexed: 12/18/2022] Open
Abstract
We report a case of pubic symphysis diastasis, which was initially asymptomatic; however, it became symptomatic with urinary incontinence during pregnancy. The patient was treated with open reduction and internal fixation of the symphysis pubis. A corticocancellous autograft was used for filling the gap which remained despite bilateral compression of the iliac bones. We obtained satisfactory outcome in terms of symptoms at the 3 years' follow-up; however, there was instability findings in the X-rays with broken screws. We conclude that asymptomatic pubic symphysis diastasis might be symptomatic after additional trauma (such as pregnancy) in the following days, if it was unstable in the very beginning of injury. Fixation of old pubic symphysis diastasis with reconstruction plate by filling the gap by using corticocancellous autograft, might not prevent ultimate implant failure if the symphysis pubis diastasis is part of an unstable pelvic fracture in the very beginning.
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Affiliation(s)
- Hasan Bombaci
- Department of Orthopaedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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Erickson D, Low J, Shumway J. Management of Postpartum Diastasis of the Pubic Symphysis. Orthopedics 2016; 39:e367-9. [PMID: 26966940 DOI: 10.3928/01477447-20160307-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/22/2015] [Indexed: 02/03/2023]
Abstract
Conservative management is typically recommended for postpartum diastasis of the pubic symphysis, despite significant functional disability and chronic pain associated with this condition. With a reported incidence of 1:500, the authors describe diagnosis and management controversies with an additional review of relevant literature related to the management of this orthopedic condition. The case is of a 27-year-old woman diagnosed with 5.5-cm diastasis of the pubic symphysis after spontaneous vaginal delivery of a 5 lb 5 oz infant. She underwent early orthopedic surgical correction via open reduction and internal fixation. The patient achieved pain-free ambulation within 3 months of surgery, and returned to full activity at 6 months. Postpartum diastasis of the pubic symphysis is typically treated conservatively; however, the authors illustrate that early orthopedic consultation and intervention at diastasis greater than 5 cm may improve recovery and functional outcome.
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Coelho KS, Shintre H, Shyamkul A, Rani B. Rent in the Vent: A Rare Event: Parturition-Induced Rupture of Pubic Symphysis and Dislocation of Sacroiliac Joint After Spontaneous Vaginal Delivery. J Obstet Gynaecol India 2016; 66:590-593. [PMID: 27803516 DOI: 10.1007/s13224-015-0798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kiran S Coelho
- Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Hemant Shintre
- Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Mumbai, India ; Lilavati Hospital and Research Centre, Mumbai, India
| | - Ashish Shyamkul
- Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Bindu Rani
- Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Mumbai, India
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Abstract
OBJECTIVE The aim of this study was to determine the risk factors, clinical and radiologic criteria for diagnosis, and management of this unusual complication of pregnancy. METHODS A PubMed and Web of Science search was undertaken with no limitations on the number of years searched. RESULTS There were 36 publications identified, with 19 articles being the basis of this review. Multiple risk factors have been identified including multiparity, macrosomia, cephalopelvic disproportion, forceps deliveries, precipitous labor, malpresentation, prior pelvic trauma, and use of the McRoberts maneuver. The diagnosis is usually made clinically, confirmed by imaging, and considered pathological when the intrapubic gap is greater than 10 mm. Magnetic resonance imaging appears to be superior to pelvic x-ray and computed tomography scan in visualization of the bone separation. Conservative treatment remains the first choice for therapy, but women who do not respond to conservative therapy or women with large separations may need surgical stabilization with external or internal fixation. CONCLUSIONS Widening of the pubic symphysis greater than 10 mm is pathologic. The diagnosis is clinical and confirmed by imaging studies, with magnetic resonance imaging being the superior technique. Conservative treatment is the first line of therapy. Failure of conservative therapy is treated by surgical stabilization.
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Urraca-Gesto MA, Plaza-Manzano G, Ferragut-Garcías A, Pecos-Martín D, Gallego-Izquierdo T, Romero-Franco N. Diastasis of symphysis pubis and labor: Systematic review. ACTA ACUST UNITED AC 2016; 52:629-40. [PMID: 26560443 DOI: 10.1682/jrrd.2014.12.0302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/23/2015] [Indexed: 11/05/2022]
Abstract
Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic girdle. Although conservative approaches are often used to decrease symptoms and interpubic separation, notably few studies have analyzed the effect of these methods on managing the symptoms of women with SPD. The purpose of this study was to review the available literature on the conservative treatment of SPD during pregnancy and labor. A computer-based search using PubMed, PEDro, and CINAHL was performed up to November 2014. We selected all studies that considered women with SPD during pregnancy or labor and treated them with conservative methods and excluded those that included surgical intervention. Eighteen studies were selected, most of which were case reports. Although the overall results of conservative treatment were unclear because of the type and design of the obtained studies, most of the studies reported bed rest in the lateral decubitus position and a pelvic girdle as basic treatments. Additionally, the few clinical trials reported recommended additional physiotherapy, including strengthening and stabilizing exercises, to reduce SPD symptoms.
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Affiliation(s)
- M Alicia Urraca-Gesto
- Department of Rehabilitation and Physiotherapy, University Hospital Alcorcón Foundation, Madrid, Spain
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Abstract
The art of symphysiotomy for delivery in the instance of cephalopelvic disproportion has been a dying art since the advent of caesarean section but in Ireland this surgical procedure was not abolished until 1992. This practice is still present in the developing world and in some circumstances used in developed countries. This study offers some insights on the 40-year follow-up of patients who had undergone symphysiotomy.
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Affiliation(s)
- S R Shaarani
- a Orthopaedic Registrar, Department of Orthopaedic Surgery , Cappagh National Orthopaedic Hospital , Finglas, Dublin , Ireland
| | - W van Eeden
- b Medical Student, Royal College of Surgeons in Ireland , Dublin , Ireland
| | - J M O'Byrne
- c Abraham Colles Professor in Orthopaedic and Trauma Surgery, Royal College of Surgeon in Ireland and Cappagh National Orthopaedic Hospital , Dublin , Ireland
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