Peripartum Pubic Symphysis Separation

Abstract

Peripartum pubic symphysis separation is a recognized complication of pregnancy with incidence estimates ranging from 1:300 to 1:30,000. Characteristic symptoms of symphyseal separation include suprapubic pain and tenderness with radiation to the back of legs, difficulty ambulating, and occasionally, bladder dysfunction. Clinical history, presenting symptoms, and response to therapy are sufficient to make the diagnosis, although radiographic documentation of symphyseal separation by x-ray or ultrasound are frequently used to confirm the diagnosis. The underlying etiology of symptomatic symphyseal separation has not been fully elucidated. Associations with multiparity, macrosomia, pathological joint loosening, and increased force placed on the pelvic ring have been suggested as possible etiologies. Conservative therapy, including bedrest, pelvic binders, ambulation devices, and mild analgesics usually result in a complete recovery with 4 to 6 weeks. The occurrence of a symphyseal separation should not significantly alter the management of subsequent pregnancies, and conservative therapy is recommended for any recurrence of symptoms. A retrospective review of our experience with 5121 deliveries from 1994 to 1995 found 9 cases of peripartum symphyseal separation, resulting in an incidence of 1 of 569 deliveries. Details regarding this case series and a review of the literature are presented.

Diastasis of symphysis pubis and labor: Systematic review

“…The present systematic review found use of physiotherapy as the main component of conservative treatment for the majority of women with SPD [1,4,7,10,12,[18][19][20][21]24,[27][28]. Most of the studies employed physiotherapy for walking reeducation, mobilization under supervision, and/or strengthening the core muscles, although only two studies detailed the stabilizing and/or strengthening exercises [10,15].…”

“…Additionally, although she returned to her normal activities 1 yr later, she had a residual 1.3 cm interpubic gap after 2 yr [1]. Snow and Neubert performed a retrospective case series study of 9 women with SPD (route of delivery: vaginal, number of infants delivered not specified) who received physiotherapy and TENS, in addition to bed rest, pain control with nonsteroidal anti-inflammatory drugs, and a pelvic girdle, but the authors did not describe any specific results [7]. Scriven et al analyzed 9 women with SPD (route of delivery: vaginal, 6 single babies and 3 twins, mean weight of babies 3.4 ± 0.8 kg) who received physiotherapy and supervised mobilization and reported a decrease in the interpubic gap from 2 cm on average to normal measures, but 4 women continued to have pubic pain, 2 had lower back pain, and 2 were severely incapacitated at the last follow-up, which was 37 mo later on average [26].…”

“…Women often have pain and inflammation in the pubic symphysis, which may radiate into the lumbar and thigh areas, mainly in the medial regions. Moving, bearing a load, or raising a leg may often increase the symptoms and cause instability and incapacity while walking or standing [2][3][4][6][7].…”

“…The clinical approach to SPD uses conservative methods, although surgical reduction is recommended when the diastasis is greater than 4 cm or patients are required to bear loads quickly after delivery [7][8]. Conservative methods suggest lateral decubitus bed rest, a pelvic girdle, walking aids, and progressive mobilization [9][10], although some clinicians also use pelvic traction [7].…”

“…Conservative methods suggest lateral decubitus bed rest, a pelvic girdle, walking aids, and progressive mobilization [9][10], although some clinicians also use pelvic traction [7]. Physical exercise seems to play a role in the prophylaxis of SPD [11].…”