Symphysis pubis dysfunction: a practical approach to management

Abstract

Symphysis pubis dysfunction is a relatively common and debilitating condition affecting pregnant women. It is painful and can have a significant impact on quality of life, which can lead to potentially serious complications such as depression. Effective management remains difficult to determine because of a variation in reported occurrence rates and symptomatology. There is little published assessment of treatments and no standardised management protocols are available. This article describes recent developments and discusses the controversies surrounding its treatment. With an improved knowledge of the condition and incorporation of the recommendations in this article it is hoped that healthcare professionals will be able to reduce the severity of the symptoms in those women affected.

Peripartum pubic symphysis separation – Current strategies in diagnosis and therapy and presentation of two cases

“…In cases of continuing pregnancy, therapy is similar. Jain et al showed that an indication for C-section with symphyseal widening causing a change to the birth canal, or when hip abduction is severely restricted [17].…”

“…Metabolic, enzymatic, traumatic and also degenerative factors have been reported as causes of symphysis widening (see Table 1) [15,16]. Overall, faulty endocrine regulation and concomitant laxity of the symphyseal ligamentous apparatus appear responsible for symphyseal rupture; however, the exact pathogenesis cannot be detected [17].…”

“…Should conservative treatment fail, the indications for operative therapy can be discussed [17,18,24]. Indications are persistent pain, inadequate reduction of symphyseal widening, and renewed diastasis after removal of the pelvic brace [33].…”

Disjonction symphysaire après un accouchement par voie basse dystocique: à propos d’un cas

“…7% des parturientes ont cette symptomatologie en post partum [3, 4]. Les étiologies de cette affection restent mal connues bien que plusieurs auteurs ont rapporté l'association fréquence de la disjonction symphysaire et certains facteurs de risque notamment la macrosomie foetale, les manoeuvres d'extraction, les pathologies articulaires et les traumatismes de l'articulation pubienne [5, 6].…”

Bioarchaeological investigation of an obstetric death at Huigou site (3900–2900 BC), Henan, China

“…The increase in pubic symphysis spacing is normally small, usually on the order of 2-5 mm (Becker et al, 2010;Herren et al, 2015) and normally no more than 10 mm (Senechal, 1994;Shanghai First Medical College, 1978). In rare cases, diastasis (abnormal separation of the symphysis) may occur secondary to factors such as large foetal size; this is characterized by separation of 10 mm or more and can be associated with significant postpartum pain and difficulty walking (Herren et al, 2015;Jain, Eedarapalli, Jamjute, & Sawdy, 2006). In the case of M70-1, field observations showed an in situ pubic symphysis opening of about 3.5 cm.…”