PERIPARTUM PUBIC SYMPHYSIS DIASTASIS: DIAGNOSIS AND MANAGEMENT IN 2023

Abstract

Problem Statement: Peripartum Pubic Symphysis Dastasis (PPSD) 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 appropriately diagnosed prior to discharge from hospital. Considering that PPSD is a rare condition, it can be at times difficult to diagnose and can be confused with pelvic girdle pain. Some risk factors for this condition include macrosomia, operative procedures/maneuvers during the delivery, degenerative changes in the sacroiliac joints, increased release of relaxin, estrogen and progesterone. This condition is often treated conservatively but surgery is sometimes needed 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 obstetric triage area in active labor. She received an 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 symphis 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 in the outpatient for physical therapy and further management.

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 PPSD 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 PPSD and have pain with difficulty walking after delivery. Early diagnosis with early mobility assistance during their post-partum stay is crucial in the management of PPSD. Outpatient physical therapy is also crucial to their recovery and return to normal daily activities.

The authors have no relevant financial disclosures.

Institutional review board (IRB) approval not required because this is a case report.