Post-partum management of severe pubic diastasis

Mulchandani, Neil; Jauregui, Julio J.; Abraham, Rachel; Seger, Edward W.; Illica, E

doi:10.12891/ceog3533.2017

Cited by 7 publications

(2 citation statements)

References 10 publications

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“…Recovery durations in these cases have varied from 6 weeks to 6 months [12]. Additionally, a notable case highlighted by Mulchandani et al underscored the potential for sustained diastasis reduction even a year after the completion of conservative treatment interventions [13]. This review provides valuable insights into the management of postpartum pubic symphysis dysfunction and its long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management Controversies Illustrated by an Uncommon Case of Postpartum Pubic Symphysis Diastasis

Bickley,

Blasini,

Johnson

et al. 2023

Osteology

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Pubic symphysis diastasis is a complication of pregnancy that can lead to prolonged recovery, persistent pain, and functional disability if managed inappropriately. There is a lack of universally accepted clinical guidelines with regards to the timeframe and defect criteria for surgical management, which contributes to delayed care resulting in increased surgical complexity and subsequent impairments in functionality and quality of life. The current standard of care utilizes non-operative measures exclusively for separations measuring less than 2.5 cm correlating to symphyseal ligament sparing. Surgical interventions are typically reserved for severe cases or those resistant to initial non-operative treatment. Non-surgical methods have been attempted for 4–6 weeks, even in severe cases, with patients still requiring eventual surgery. We herein report an uncommon case of pubic symphysis diastasis measuring 5.5 cm and the successful implementation of non-surgical management to demonstrate the need for updated standardized treatment guidelines. The defect in this case was treated with early application of a pelvic binder resulting in anatomic alignment and full resolution of pain within 3 months, and full return to activity within 6 months. In conclusion, the establishment of management guidelines for pubic symphysis is recommended, including the use of non-surgical management early in the patient recovery process and in cases with diastasis greater than 2.5 cm. This treatment strategy may decrease morbidity, recovery time, and complications in affected patients.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Management Controversies Illustrated by an Uncommon Case of Postpartum Pubic Symphysis Diastasis

Bickley,

Blasini,

Johnson

et al. 2023

Osteology

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“…When reviewing the literature, most patients with PSD reported symptoms within the first week of PP. Patients who experience PSD during delivery may report acute anterior pelvic pain, an inability to ambulate following delivery, and “feeling a pop” during delivery [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Postpartum Pubic Symphysis Diastasis: A Case Report

Vilar,

Donahue,

Nadella

et al. 2024

Cureus

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We present the case of a 25-year-old African American female patient (G1P0) with a past medical history of brain arteriovenous malformation repair, pneumonia, and a urinary tract infection who was admitted to the labor and delivery floor at 39 weeks for a spontaneous vaginal delivery of a 4.025 kg female baby. In the immediate postpartum (PP) period, the patient presented with severe pelvic pain and trouble ambulating. Conservative management of oral non-narcotic analgesics was initiated until the diagnosis of PP pubic symphysis diastasis (PSD) was made. Due to the persistence of pelvic pain, the patient underwent a pubic symphysis joint steroid injection and was discharged on day 8. Within 24 hours of discharge, the patient was readmitted to the emergency department with severe pain and an inability to walk. Her pain was managed conservatively with intravenous narcotics and non-steroidal anti-inflammatories, which quickly dissipated the pain. She was observed and discharged once she reported improvement in pain, and she was reassessed five days later at her obstetrician’s clinic. In the clinic, the patient presented with mild tenderness in the pubic symphysis region but demonstrated improvement in her antalgic gait with an ability to walk and urinate without difficulty. Despite a lack of follow-up imaging, the patient was reassured that her PSD and associated tenderness should completely resolve within three to four months.

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