The aim of this study was to determine the risk factors, clinical and radiologic criteria for diagnosis, and management of this unusual complication of pregnancy.
A PubMed and Web of Science search was undertaken with no limitations on the number of years searched.
There were 36 publications identified, with 19 articles being the basis of this review. Multiple risk factors have been identified including multiparity, macrosomia, cephalopelvic disproportion, forceps deliveries, precipitous labor, malpresentation, prior pelvic trauma, and use of the McRoberts maneuver. The diagnosis is usually made clinically, confirmed by imaging, and considered pathological when the intrapubic gap is greater than 10 mm. Magnetic resonance imaging appears to be superior to pelvic x-ray and computed tomography scan in visualization of the bone separation. Conservative treatment remains the first choice for therapy, but women who do not respond to conservative therapy or women with large separations may need surgical stabilization with external or internal fixation.
Widening of the pubic symphysis greater than 10 mm is pathologic. The diagnosis is clinical and confirmed by imaging studies, with magnetic resonance imaging being the superior technique. Conservative treatment is the first line of therapy. Failure of conservative therapy is treated by surgical stabilization.
Obstetricians and gynecologists, family physicians.
After completion of this educational article, the reader will be able to evaluate the published literature regarding peripartum pubic symphysis rupture and associated outcomes; recognize clinical presentation of pubic symphysis rupture following vaginal delivery; differentiate between normal and pathological separation on imaging; determine the most beneficial treatment strategy; and review recommendations regarding management of subsequent pregnancies after pubic symphysis rupture.