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Pubic symphysis diastasis in pregnancy is a rare obstetric complication. A case of a 35 year old primigravid woman with severe pubic symphysis diastasis and sacroiliac joint relaxation during non-operative vaginal delivery is reported and the literature reviewed. The patient was successfully treated by open reduction and internal fixation with plate and screws. During a 5 year follow-up, the patient presented with no pain and complete recovery to pre-injury functional level. Early diagnosis and immediate intervention by pelvic stabilization and in severe cases surgical intervention are the key points for the management of pubic symphyis diastasis, which optimize the maternal outcome.