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Peripartum Pubic Symphysis Separation: A Case Report and Review of the Literature

Nitsche, Joshua F. MD, PhD*; Howell, Thomas MD

Obstetrical & Gynecological Survey: March 2011 - Volume 66 - Issue 3 - p 153-158
doi: 10.1097/OGX.0b013e31821f84d9
CME Program: CME REVIEW ARTICLE 7

Although peripartum pubic symphysis diastasis is an uncommon complication of delivery, it can lead to considerable and sometimes long-term disability. Although the initial clinical examination and diagnostic workup for this complication are relatively straightforward, the best treatment for a peripartum pubic symphysis diastasis is less clear. Historically, nearly all women were treated conservatively with bed rest and pelvic binders. However, more recent case reports have described more invasive orthopedic procedures being used to help speedy recovery. In this study, we present a case of a 22-year-old primigravida who had a severe pubic symphysis separation after a vaginal delivery complicated by a shoulder dystocia. We also reviewed the literature on this topic over the past 20 years to gain a better understanding of the clinical factors surrounding peripartum pubic symphysis separation and the treatment option available to women with this complication.

Target Audience: Obstetricians & Gynecologists

Learning Objectives: After completing this CME activity, physicians should be better able to identify the clinical factors that associated with peripartum pubic symphysis separation; perform a diagnostic workup when a peripartum pubic symphysis separation is suspected; distinguish the conservative and invasive orthopedic interventions available for the treatment of peripartum pubic symphysis separation; and show that the degree of patient disability after peripartum pubic symphysis separation varies greatly and no clinical factors or diagnostic studies effectively predict the course of patient recovery.

*Fellow, Division of Maternal Fetal Medicine, Department of OB/GYN, Mayo Clinic College of Medicine, Rochester, MN; and †Physician, Department of OB/GYN, District One Hospital, Faribault, MN

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commerical organizations pertaining to this educational activity.

Correspondence requests to: Joshua F. Nitsche, MD, PhD, Division of Maternal Fetal Medicine, Department of OB/GYN, Mayo Clinic College of Medicine, 200 First St, Rochester, MN 55901. E-mail: nitsche.joshua@mayo.edu.

© 2011 Lippincott Williams & Wilkins, Inc.