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!
Rupture of the symphysis pubis during labor.
Dhar S; Anderton JM
Countess of Chester Hospital, England.
Clin Orthop, 283, 1992 Oct, 252-7
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.
Symphysis pubis separation during childbirth.
Department of Family Practice, 646th Medical Group, Eglin AFB, Florida 32542-1281.
J Am Board Fam Pract, 7: 2, 1994 Mar-Apr, 141-4
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.
Symphysis pubis separation during vaginal delivery with epidural anesthesia. Case report.
Musumeci R; Villa E
Department of Anesthesia and Critical Care, Beth Israel Hospital, Springfield, Massachusetts.
Reg Anesth, 19: 4, 1994 Jul-Aug, 289-91
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.
Traumatic separation of the symphysis pubis during pregnancy: a case report.
Luger EJ; Arbel R; Dekel S
Department of Orthopaedics B, Tel Aviv Medical Center, Israel.
J Trauma, 38: 2, 1995 Feb, 255-6
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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