Presentation
Severe pain in the pubic area following a normal vaginal delivery.
Patient Data
Pelvic x-ray demonstrates wide separation of symphysis pubis up to 4.5 cm.
Case Discussion
Primigravidae was referred for traumatic PPH and severe pain in the pubic area following a normal vaginal delivery of a 4 kg full-term healthy baby. The administration of oxytocin was controlled and lab investigation revealed hemoglobin of 7.7%.
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. Under adequate exposure vaginal and cervical tear was sutured and complete hemostasis was achieved, followed by adequate compatible blood transfusion.
This patient was managed conservatively by external pelvic binder, immobilization and analgesics.
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