Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2020; 8(1): 110-119
Published online Jan 6, 2020. doi: 10.12998/wjcc.v8.i1.110
Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature
Kristina Norvilaite, Monika Kezeviciute, Diana Ramasauskaite, Audrone Arlauskiene, Daiva Bartkeviciene, Valentinas Uvarovas
Kristina Norvilaite, Diana Ramasauskaite, Audrone Arlauskiene, Daiva Bartkeviciene, Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania
Monika Kezeviciute, Vilnius University, Institute of Clinical Medicine, Faculty of Medicine, Vilnius LT-08661, Lithuania
Valentinas Uvarovas, Department of Orthopedics and Traumatology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-08661, Lithuania
Author contributions: Norvilaite K, Kezeviciute M, Ramasauskaite D, Arlauskiene A, Bartkeviciene D, Uvarovas V analyzed the clinical cases, reviewed the literature and contributed to manuscript drafting, all authors approved the final version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kristina Norvilaite, MD, Doctor, Lecturer, Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, No. 2 Santariskiu street, Vilnius LT-08661, Lithuania. kristina.norvilaite@gmail.com
Received: September 25, 2019
Peer-review started: September 25, 2019
First decision: November 11, 2019
Revised: November 18, 2019
Accepted: November 27, 2019
Article in press: November 27, 2019
Published online: January 6, 2020
Abstract
BACKGROUND

Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy. As it is a rare pathology (ranging from 1 in 300 to 1 in 30000 pregnancies), no gold standard treatment has been defined.

CASE SUMMARY

This study examines two cases, a 27-year-old woman (gravida 1, para 1) and a 32-year-old woman (gravida 2, para 2), who presented to the clinic after uneventful vaginal deliveries. A normal pregnancy with no complications was observed in both patients. Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion. Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended. Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations. The symptoms decreased after treatment. Post-treatment magnetic resonance imaging (MRI) in the first case showed a reduction in symphyseal separation with no signs of osteitis. Three years later the symptoms recurred; MRI examination showed no further symphyseal widening or signs of osteitis. A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery. In the second case, pain recurred when the patient conceived for the second time. This time no benefit following conservative treatment was observed. Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy, thus surgical treatment was chosen and internal pubic synthesis was performed.

CONCLUSION

Overall, surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.

Keywords: Pubic symphysis diastasis, Conservative treatment, Internal pubic synthesis, Pregnancy, Vaginal delivery, Case report

Core tip: Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy. As it is a rare pathology and no gold standard treatment is defined, we present two cases with severe pain in the pubic region after labour, accompanied by complicated locomotion. Pubic symphysis diastasis was confirmed radiologically in both cases and conservative treatment was recommended. No benefit following conservative treatment was observed, thus surgical treatment was selected and internal pubic synthesis was performed. These cases show that standardisation of conservative and surgical treatment or studies of possible complications have not been defined; therefore, postoperative infections are likely to complicate surgical treatment. Overall, our findings demonstrate the significance of an accurate choice between conservative and surgical treatment due to possible complications after surgical intervention such as infection, loose screws, fistula and repeated surgical management.