Images in Clinical Medicine
Peripartum Diastasis of the Symphysis Pubis
N Engl J Med 2009; 361:1886November 5, 2009
- Article
A 21-year-old primigravida at nearly 40 weeks' gestation presented with a spontaneous onset of pelvic pain and difficulty in walking. After a rapid delivery, the postpartum physical examination revealed pain only with weight bearing and abduction and adduction at both hips. Pelvic radiography showed a 23-mm diastasis of the symphysis pubis (arrow). The reported incidence of nontraumatic diastasis varies widely, from 1 in 300 pregnancies to 1 in 30,000 pregnancies. In a nonpregnant woman, the normal pubic symphysis gap ranges from 4 to 5 mm. With pregnancy, the gap increases by at least 2 to 3 mm, which is thought to be caused by the slackness of ligaments supporting the joint. The diagnosis of diastasis is based on the persistence of symptoms and a symphysis pubis separation of more than 10 to 13 mm on imaging. Treatment is conservative, with bed rest and gradual mobilization if the diastasis is less than 25 mm, but extreme cases may require surgery. Although the condition may recur, the prognosis for subsequent pregnancies remains good. The patient was treated with oral analgesics and physical therapy, with excellent results.
Jason M. Parker, M.D.
Modushudan Bhattacharjee, M.B., B.S.
University of Texas Medical School, Houston, TX
modushudan.bhattacharjee@uth. tmc. edu - Citing Articles (1)
Citing Articles
1
Joshua F. Nitsche, Thomas Howell. (2011) Peripartum Pubic Symphysis Separation: A Case Report and Review of the Literature. Obstetrical & Gynecological Survey 66:3, 153-158
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