Agustín-Oliva A, Díaz-Rabasa B, Estallo-Bernardos V, Rodríguez-Solanilla B, Padin-Fabeiro M, Castán-Mateo S

Language: Spanish
References: 20
Page: 396-402
PDF size: 405.75 Kb.

ABSTRACT

Background: In the presence of severe pelvic pain in a pregnant patient, during childbirth or the immediate puerperium, it is necessary to consider the possibility of a diastasis of the pubic symphysis. It is a rare and underdiagnosed pathology that can be very painful and invalidating and seriously worsens the quality of life. Physical examination shows intense pain at the level of the pubic symphysis that can radiate towards the lower back or both thighs. Definitive diagnosis requires an image test showing a separation between the two pubic bones ≥10 mm. Depending on symptomatology and the degree of separation, it is possible a conservative treatment or surgery, with osteosynthesis and stabilization of the pelvic ring.
Clinical case: Patient who experienced intense pelvic pain and incapacity for ambulation and sedation after a eutocic delivery for ambulation and sedestation. After an anteroposterior radiograph of the pelvis, a severe diastasis of the pubic symphysis was diagnosed with affectation of the sacroiliac joint and required surgical treatment with a favourable evolution.
Conclusions: Mild forms of this condition are underdiagnosed. Delay in diagnosis and treatment involves residual pain and worsens the prognosis of the disease. It is important to keep this diagnosis in mind at the time of the differential diagnosis of pelvic pain in a pregnant or puerperal patient.

REFERENCES

1. Jain S, Eedarapalli P, Jamjute P, Sawdy R. Symphysis pubis dysfunction: a practical approach to management. The Obstetrcian & Gynaecologist. 2011 Jan; 8(3): 153-158.

2. Yoo JJ, Ha YC, Lee YK, Hong JS, Kang BJ, Koo KH. Incidence and risk factors of symptomatic peripartum diastasis of pubic symphysis. J Korean Med Sci. 2014 Feb; 29(2): 281-6.

3. Boraiah S, Krishna SA, Rangappa SS. Rare occurrence of symphysis pubis diastasis following normal vaginal delivery. J Obstet Gynaecol India. 2013 Dec; 63(6): 418-9.

4. Hierholzer C, Ali A, Toro-Arbelaez JB, Suk M, Helfet DL. Traumatic disruption of pubis symphysis with accompanying posterior pelvic injury after natural childbirth. Am J Orthop (Belle Mead NJ). 2007 Nov; 36(11): E167-70.

5. Dunbar RP, Ries AM. Puerperal diastasis of the pubic symphysis. J Reprod Med. 2002 July; 47(7): 581-3.

6. Khorashadi L, Petscavage JM, Richardson ML. Postpartum symphysis pubis diastasis. Radiology Case Reports. 2011; 6(3): 542.

7. Budak MJ, Oliver TB. There`s a hole in my symphysis- A review of disorders causing widening, erosion, and destruction of the symphysis pubis. Clinical Radiology. 2013;(68): 173-180.

8. Fidan U, Ulubay M, Keskin U, Firathgil FB, Karasahin KE, Ege T, et al. Postpartum symphysis pubis separation. Acta Obstet. Gynecol. Scand. 2013; 92: 1335-39.

9. Joosoph J, Kwek K. Sympysis pubis diastasis after normal vaginal birth: a case report. Ann. Acad. Med. Singap. 2007 Jan; 36(1): 83-85.

10. Urraca-Gesto MA, Plaza-Manzano G, Ferragut-Garcías A, Pecos-Martin D, Gallego-Izquierdo T, Romero-Franco N. Diastasis of symphysis pubis and labor: systematic review. JRRD. 2015; 52(6): 629-640.

11. Keriakos R, Bhatta C, Morris F, Mason S, Buckley S. Pelvic girdle pain during pregnancy and puerperium. J Obstet Gynaecol. 2011 Oct; 31(7): 572-80.

12. Pires RES, Labronici PJ, Giordano V, Kojima KE, Kfuri M, Barbisan Mea. Intrapartum pubic symphysis disruption. Ann. Med. Health. Sci. Res. 2015; 5: 476-9.

13. Reis RA, Baer JL, Arens RA, Stewart E. Traumatic separation of the symphysis pubis during spontaneous labour. Surg Gynecol Obstet. 1932;(55): 336-54.

14. Taylor RN, Sonson RD. Separation of the pubic symphysis, an underrecognized peripartum complication. J Reprod Med. 1986; 31: 203-206.

15. Kharrazi FD, Rodgers WB, Kennedy JG, Lhowe DW. Parturition induced pelvic dislocation: a report of four cases. J. Orthop. Trauma. 1997 May; 11(4): 277-81.

16. Svelato A, Ragusa A, Perino A, Meroni MG. Is X-Ray compulsory in pubic symphysis diastasis diagnosis? AOGS. 2014; 93: 218-220.

17. Scriven MW, McChir DAJ, McKnight L. The importance of pubic pain followin childbirth: a clinical and ultrasonographic study of diastasis of the pubis symphysis. J R Soc Med. 1995 Jan; 88: 20-30.

18. Björklund K, Bergström S, Nordström ML, Ulmsten U. Symphyseal distention in relation to serum relaxin levels and pelvic pain in pregnancy. AOGS. 2000 Apr; 79(4): 269-275.

19. Aggarwal S, Bali K, Krishnan V, Kumar V, Meena D, Sen RK. Management outcomes in pubic diastasis: our experience with 19 patients. J Orthop Surg Res. 2011 May; 17: 6:21.

20. Culligan P, Hill S, Heit M. Rupture of the symphysis pubis during vaginal delivery followed by two subsequent uneventful pregnancies. Obstet Gynecol. 2002; 100(5 Pt 2): 1114-7.