Case reportRupture of the symphysis pubis during vaginal delivery followed by two subsequent uneventful pregnancies
Section snippets
Case
A young, healthy primigravida experienced spontaneous rupture of membranes followed by spontaneous labor at 37 weeks’ gestation. Her pregnancy had been uneventful. Cervical dilatation progressed to 4 cm 2 hours after her membranes ruptured and she was given epidural anesthesia. She progressed through the active phase of labor without oxytocin augmentation, and was fully dilated 6 hours after the placement of her epidural catheter. She then pushed for approximately 30 minutes. During the final
Comment
Relaxation of the symphysis pubis and sacroiliac joints normally begins in the first half of pregnancy, increases during the third trimester, and returns to baseline within 5 months postpartum.1 When widening of the symphysis pubis reaches 1 cm, patients usually become symptomatic and can be classified as having symphyseal separation.1 The reported incidence of symphyseal separation ranges from one in 300 to one in 5000 live births.2, 3 Symptoms include severe iliosacral and suprapubic pain as
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Cited by (46)
Disjunction of the symphysis pubis after vaginal delivery: Case report
2023, International Journal of Surgery Case ReportsPubic disjunction following vaginal delivery in a multiparous woman: A case report
2021, Annals of Medicine and SurgeryCitation Excerpt :The incidence of pubic disjunction syndrome in the peripartum is estimated between 1/300 and 1/30,000 in the literature [4,5], in fact 22 % of parturients may have pain at the level of the pubic symphysis, this pain is excruciating in 5–8% of parturients and 7 % of parturients have this symptomatology in the post partum period [6,7]. The etiologies of this syndrome are still poorly understood, although some authors incriminate multiparity, fetal macrosomia, extraction maneuvers, joint pathologies and trauma of the pubic joint [8,9]. In the clinical case reported, the patient had multiparity as a risk factor.
Red herring: Acute back pain after combined spinal epidural for labor analgesia
2018, Egyptian Journal of AnaesthesiaCitation Excerpt :A marker of delayed recovery suggested include a large sonographically measured interpubic gap greater than 21 mm [16]. Patients should be aware that symptoms may recur in subsequent pregnancies, which may worsen, though this does not preclude vaginal delivery [1,17]. Early recognition and treatment would aim to avoid major functional difficulties and improve quality of life in mothers.
Acute Intrapartum Rupture of the Pubic Symphysis Requiring Resuscitation and Surgical Intervention: A Case Report
2018, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :In the absence of another obstetrical indication, previous pubic symphysis diastasis not requiring surgery should not be a strong indicator for a future Caesarean section.9 Alternatively, given the absence of well-defined risk factors and the possibility of recurrence, offering elective Caesarean section is not unreasonable.7,8,12,13 After ORIF, Caesarean section is recommended by most, although vaginal delivery is not contraindicated and cases have been reported.7,14
Management of pelvic injuries in pregnancy
2013, Orthopedic Clinics of North AmericaCase report: Physiotherapy strategies for a woman with symphysis pubis diastasis occurring during labour
2012, PhysiotherapyCitation Excerpt :SPD is usually associated with discomfort in the pelvis and upper thigh, leading to difficulty in walking [3]. Most cases of nontraumatic SPD resulting from normal vaginal delivery can be successfully managed with conservative treatment, including bed rest, analgesia, and activity restriction [4]. However, little clinical data has been published on functional rehabilitation, and no standardized treatment protocols are available for clinical physiotherapy setting.