Symphysis pubis diastasis following normal vaginal delivery
22 year old primigravidae who was referred from a taluk hospital at 6:30pm in the evening for traumatic PPH and severe pain in the pubic area following a normal vaginal delivery of a 4 kg full term healthy female baby the same afternoon at 4:00pm. The administration of oxytocin was controlled and no overdose of this drug was given, neither prolongation of delivery time nor it was an instrumental delivery. On examination patient vitals were stable. Lab investigation revealed hemoglobin of 7.7% blood group B positive. Severe tenderness was elicited in the symphysis pubis and a wide pubic symphyseal diastasis was present on palpation and the separated bony ends was obvious on abduction of thighs. Per speculum examination showed bilateral cervical tear with avulsion of anterior vaginal wall. Anterior wall of bladder was seen through the separated space of Retzius with displacement of urethra and clitoris laterally as shown in figure one.Under adequate exposure vaginal and cervical tear was sutured and complete hemostasis achieved, followed by adequate compatible blood transfusion .
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Pelvic x-rays demonstrates wide separation of symphysis pubis up to 4.5 cm.
This patient was managed conservatively by external pelvic binder, immobilization and analgesics.