Parturition-induced pelvic instability is a rare condition seen in women following vaginal delivery.
The incidence of symphyseal rupture after vaginal delivery ranges from one in 600 to one in 30,000 deliveries 1.
Predisposing factors include multiparity, complicated delivery, forceps or vacuum assisted delivery, shoulder dystocia, maternal hip dysplasia or prior pelvic trauma, hyperabduction of the thighs and epidural anaesthesia 3-4.
Peripartum ligamentous relaxation with moderate widening of the pubic symphysis and sacroiliac joints is physiologic and occurs regularly. It is thought to be hormonally mediated by relaxin and progesterone 2. Physiologic peripartum symphyseal widening ranges from 3 to 7 mm and often remains asymptomatic. Slight pubic diastasis in the absence of clinical symptoms is frequent and does not necessitate medical treatment. After delivery, laxity of these ligaments gradually diminishes, the pubic diastalsis disappears, and pelvic stability is restored.
Treatment and prognosis
Treatment of postpartum symphyseal rupture has traditionally been non-operative and conservative 5-6. Bed rest, usually in a decubitus position, analgesics and the application of a pelvic binder to facilitate reduction of the diastalsis are sufficient to ensure full recovery in most case. The successful surgical treatment of the chronic postpartum pelvic pain usually is anterior pubic fixation with or without sacroiliac joint stabilisation.
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.
- 1. Taylor RN, Sonson RD. Separation of the pubic symphysis. An underrecognized peripartum complication. The Journal of Reproductive Medicine. 1986 Mar;31(3):203-6.
- 3. Cappiello GA, Oliver BC: Rupture of the symphysis pubis caused by forceful and excessive abduction of the thighs with labor epidural anesthesia, The Journal of Florida Medical Association 1995, 82:261-263.
- 4 Musumeci R, Villa E. Symphysis pubis separation during vaginal delivery with epidural anesthesia, Case report. Regional Anesthsia. 1994 Jul-Aug;19(4):289-91.
- 5 . Dunbar RP. Puerperal diastasis of the public symphysis. A case report. Journal of Reproductive Medicine 2002; 47: 581-3.
- 6. Omololu AB, Alonge TO, Salawu SA. “Spontaneus pubic symphysial diastasis following vaginal delivery. African Journal Medicine and Medical Sciences 2001; 30: 133-5.
- 2. Putschar WG: The structure of the human symphysis pubis with special consideration of parturition and its sequelae. American Journal of Physical Anthropology 1976, 45:589-594.