Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature

Kristina Norvilaite; Monika Kezeviciute; Diana Ramasauskaite; Audrone Arlauskiene; Daiva Bartkeviciene; Valentinas Uvarovas

doi:10.12998/wjcc.v8.i1.110

Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature

World J Clin Cases. 2020 Jan 6;8(1):110-119. doi: 10.12998/wjcc.v8.i1.110.

Authors

Kristina Norvilaite¹, Monika Kezeviciute², Diana Ramasauskaite³, Audrone Arlauskiene¹, Daiva Bartkeviciene¹, Valentinas Uvarovas⁴

Affiliations

¹ Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania.
² Vilnius University, Institute of Clinical Medicine, Faculty of Medicine, Vilnius LT-08661, Lithuania.
³ Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania. kristina.norvilaite@gmail.com.
⁴ Department of Orthopedics and Traumatology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania.

Abstract

Background: Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy. As it is a rare pathology (ranging from 1 in 300 to 1 in 30000 pregnancies), no gold standard treatment has been defined.

Case summary: This study examines two cases, a 27-year-old woman (gravida 1, para 1) and a 32-year-old woman (gravida 2, para 2), who presented to the clinic after uneventful vaginal deliveries. A normal pregnancy with no complications was observed in both patients. Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion. Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended. Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations. The symptoms decreased after treatment. Post-treatment magnetic resonance imaging (MRI) in the first case showed a reduction in symphyseal separation with no signs of osteitis. Three years later the symptoms recurred; MRI examination showed no further symphyseal widening or signs of osteitis. A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery. In the second case, pain recurred when the patient conceived for the second time. This time no benefit following conservative treatment was observed. Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy, thus surgical treatment was chosen and internal pubic synthesis was performed.

Conclusion: Overall, surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.

Keywords: Case report; Conservative treatment; Internal pubic synthesis; Pregnancy; Pubic symphysis diastasis; Vaginal delivery.

Publication types

Case Reports