PUBIC SYPHYSIS DIASTASIS: DIAGNOSIS AND MANAGEMENT

Problem Statement: Pubic symphysis diastasis (PSD) is a rare post-partum complication that can be at times debilitating for some patients. It occurs in 1 in 300 to 1 in 30,000 patients with many patients not being diagnosed. Considering that PSD is a rare condition, it can be at times difficult to diagnose and can be confused with pelvic girth syndrome. Some of the risk factors for this condition include young, small and primigravid women, who underwent a prolonged active labor, had infant macrosomia, and underwent McRoberts maneuvers during the delivery. This condition is often treated conservatively but surgery is sometimes indicated when the pubic symphysis separation is severe. The prognosis is usually great if diagnosed and treated promptly.

Case: A 23-year-old primigravid female at term gestation, presented to triage with regular contraction. She received and epidural and gave birth 24 hours later after a prolonged active labor. The infant was large for gestational age at 4560g birth weight. On post-partum day one she was found to have severe pelvic pain with significant difficulty walking.

Methods: An Xray showed pubic symphisis separation of 1.8 cm that was managed conservatively with pelvic binder and a walker while in the hospital. She was discharged with instructions to follow up outpatient for physical therapy.

Result: Patient had her mobility limitations improve with the use of the binder and walker. Her pelvic pain improved but it had not resolved by the time she was discharged.

Conclusion: Since PSD is a rare condition and its symptoms overlap with other conditions that can be found post-partum, it is important to do diagnostic imagining in those patients that have the risk factor criteria for PSD and have pain with difficulty walking after delivery. Early diagnosis and providing mobility assistance during their post-partum stay is crucial to allow patients to ambulate and decreased the risk of blood clots. Outpatient physical therapy is also crucial to their recovery and return to normal daily activities.

No conflitcs of interest to disclose

No insitutional review board (IRB) permission required. It is IRB exempt.