Postpartum separation of the pubic symphysis Separación de la sínfisis púbica postparto

Abstract

Pubic symphysis separation following normal vaginal delivery is uncommon. The etiology has not been fully elucidated and is associated with multiparity, macrosomia, physiological weakening of the joint or excessive force applied to the pelvic ring. Symptoms include pain around the symphysis pubis joint, hips, groin, lower abdomen and inner thigh associated with tenderness in the affected area. Imaging studies show the distance between the pubic bones. Medical management is variable and the potential results are yet poorly understood. Delay in diagnosis carries severe acute or long-term health consequences in patients. We present a case in an 18-year-old patient who complained of shearing pain in the pubic area on postnatal day 2. Past history included a normal full term pregnancy, normal spontaneous uncomplicated vaginal delivery and live-born infant. On physical examination patient had moderate pain over the pubic region associated with difficulty in walking and active leg movements. An anteroposterior radiograph of the pelvis in a supine position revealed a pubic symphyseal separation of 25 mm, with no other bone or congenital anomalies. She was treated conservatively with complete resolution of symptoms after 3 months.