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Sympysis Pubis Separation


Someone had written me and asked me a question about the occurence of separation of the symphysis pubis during pregnancy and birth. Here are some studies I found quoting the occurence rates from 1 in 521 to 1 in 30,000 (average in about 1 in 6,000). This also gives some treatment options. Enjoy!

Title
Rupture of the symphysis pubis during labor.
Author
Dhar S; Anderton JM
Address
Countess of Chester Hospital, England.
Source
Clin Orthop, 283, 1992 Oct, 252-7
Abstract

Two cases of spontaneous rupture of the symphysis pubis (SP) during delivery are reported. The separations were associated with considerable pain, swelling, and tenderness over the symphysis pubis and were confirmed roentgenographically. Both patients were treated conservatively with bed rest, mostly in the lateral decubitus position, within pelvic binders. Immobilization was discontinued when they were pain free. The SP separations remained in reduced positions. The patients were essentially asymptomatic and walked normally. Conservative treatment followed by early mobilization is adequate treatment for SP separations.

Title
Symphysis pubis separation during childbirth.
Author
Senechal PK
Address
Department of Family Practice, 646th Medical Group, Eglin AFB, Florida 32542-1281.
Source
J Am Board Fam Pract, 7: 2, 1994 Mar-Apr, 141-4
Abstract

A severe case of separation of the symphysis pubis during labor and delivery is reported, which included severe pain and unusual complications of urinary outflow incontinence and fecal incontinence that gradually resolved with conservative treatment. The incidence of symphysis pubis separation is reported to be between 1:600 and 1:3400 obstetric patients. Treatment should generally be conservative and symptomatic. Prognosis for recovery is excellent. Recurrent separation of the symphysis pubis could occur during subsequent deliveries but generally is no worse than the first occurrence. This case report illustrates the unusual complications that can occur with severe diastasis of the symphysis pubis during pregnancy. Family physicians, obstetricians, and orthopedic surgeons could encounter this complication of childbirth in their own practices. Although the symptoms are dramatically severe in presentation, a conservative management approach is effective.

Title
Symphysis pubis separation during vaginal delivery with epidural anesthesia. Case report.
Author
Musumeci R; Villa E
Address
Department of Anesthesia and Critical Care, Beth Israel Hospital, Springfield, Massachusetts.
Source
Reg Anesth, 19: 4, 1994 Jul-Aug, 289-91
Abstract

BACKGROUND AND OBJECTIVES. Peripartum pubic separation (diastasis pubis) is an uncommon event with a reported incidence varying between one in 521 to one in 30,000 deliveries. The injury is caused by the fetal head exerting pressure on pelvic ligaments that have been weakened or relaxed by the hormones progesterone and relaxin. Diastasis pubis has been previously reported in both obstetric and orthopedic literature. However, the authors have been unable to locate any discussion of this condition in the anesthetic literature. Historically, symphyseal separation has been frequently unrecognized. The authors present the case of a nulliparous woman who suffered a diastasis pubis during assisted vaginal delivery under epidural anesthesia. METHODS. Epidural catheter placement and administration of medications were performed using standard techniques described. RESULTS. The patient had an episode of breakthrough pain during labor despite adequate epidural analgesia and experienced postoperative pubic and thigh pain secondary to pubic separation. CONCLUSIONS. Diastasis pubis is an uncommon injury that should be considered when evaluating patients in the peripartum period who are experiencing suprapubic, sacroiliac, or thigh pain.

Title
Traumatic separation of the symphysis pubis during pregnancy: a case report.
Author
Luger EJ; Arbel R; Dekel S
Address
Department of Orthopaedics B, Tel Aviv Medical Center, Israel. Source
J Trauma, 38: 2, 1995 Feb, 255-6
Abstract

OBJECTIVE: To present an unusual case of traumatic extensive separation of the symphysis pubis during pregnancy and rationale for mode of treatment. DESIGN: Diagnosis for etiology of public and lower back pain following trauma in a 37-year-old woman in an advanced stage of pregnancy. METHODS: Physical examination and plain anterioposterior X-rays. CONCLUSION: Extensive traumatic separation of the symphysis pubis might result from a very forceful descent of the fetal head against the pelvic ring upon the mother's accidental falling. Propitious timing of a caesarian section permits the option of open reduction and internal fixation.

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