Images in Clinical Medicine
Spontaneous Resolution of a Pubic-Symphysis Diastasis
N Engl J Med 2002; 346:39January 3, 2002
- Article
Figure 1 A 27-year-old, 45-kg primigravid woman presented in early labor at 40 weeks' gestation. Six hours into her labor, an urgent vacuum-assisted vaginal delivery was performed because of fetal bradycardia. A healthy 3010-g male infant was delivered, with Apgar scores of 9 and 9 at one and five minutes, respectively. Immediately after delivery the patient reported anterior pelvic pain and was unable to move from the table. An anteroposterior radiograph of her pelvis was obtained while she lay on the delivery table and revealed a 5-cm diastasis of the pubic symphysis (Panel A). Because the sacroiliac joints were not disrupted and there were no other indications of pelvic instability, she was treated with pain medication and instructed to bear weight as tolerated. The pain gradually decreased over the next few weeks. Six months post partum, she was asymptomatic and healthy, and a follow-up radiograph showed that the diastasis had spontaneously resolved, leaving a gap of 1 cm (Panel B).
David Chang, M.D.
Bruce S. Markman, M.D.
San Francisco Orthopaedic Residency Program, San Francisco, CA 94117
