Peripartum Pubic Symphysis Diastasis

Abstract

Importance Peripartum separation of the pubic symphysis is a rare but potentially severe complication of childbirth, which may lead to prolonged immobilization. Thus, prompt diagnosis and treatment are paramount. Objective The purpose of this review is to define peripartum separation of the pubic symphysis and provide a thorough review of its etiology, clinical manifestations, diagnostic imaging techniques, management, and prognosis. Evidence Acquisition This was a literature review using PubMed and Google Scholar. Results Peripartum pubic symphysis separation is defined as disruption of the pubic symphysis joint and ligamentous structures with greater than 1 cm of separation during delivery. Risk factors include fetal macrosomia, nulliparity, and precipitous labor. Patients often present with a sensation of something “giving way” in the pubic symphysis area at the time of delivery, or with severe pain in the pubic symphysis region with attempted mobilization postpartum. In severe cases, associated hematomas, pelvic fractures, sacroiliac joint disruption, and urinary tract injury may be seen. Imaging such as x-ray or ultrasound may be used to confirm the diagnosis. Although most patients recover well with conservative management, orthopedic surgical intervention may be indicated in more severe or unresolved cases. Conclusions and Relevance Pubic symphysis separation is increasingly identified peripartum due enhanced accessibility and utilization of imaging modalities. It can be debilitating and lead to prolonged immobility postpartum. Therefore, early recognition and diagnosis are important, as this can guide decision-making for management. A multidisciplinary team approach, including coordination with obstetrics, orthopedic surgery, physical therapy, and occupational therapy should be used for early detection and treatment to ensure optimal patient outcomes. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, learners should be better able to define peripartum separation of the pubic symphysis and discuss the relevant anatomy involved; identify risk factors associated with peripartum separation of the pubic symphysis; describe the typical presentation of a patient with separation of the pubic symphysis and next steps in making the diagnosis; and explain both conservative and orthopedic surgical intervention methods for treatment of peripartum separation of the pubic symphysis.