%0 Journal Article
%T Treatment of Parturition-Induced Rupture of Pubic Symphysis after Spontaneous Vaginal Delivery
%A C. Gr£¿f
%A R. M. Sellei
%A S. Schrading
%A D. O. Bauerschlag
%J Case Reports in Obstetrics and Gynecology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/485916
%X Parturition-induced rupture of pubic symphysis is an uncommon but severe complication of delivery. Characteristic symptoms are an immediate onset of suprapubic and/or sacroiliac pain within the first 24 hours postpartum, often accompanied by an audible crack. Diagnosis can be confirmed by imaging including X-ray, Magnet Resonance Imaging (MRI), and ultrasound. However, there is no consensus on the optimal therapy. Conservative treatment is predominantly used. It has been reported that, in cases of extreme symphyseal rupture with pelvic instability or persisting pain after conservative therapy, operative treatment achieves a successful outcome. In this report, we present a case of a twenty-year-old primigravida who developed suprapubic pain after a nonoperative vaginal birth with shoulder dystocia. A rupture of pubic symphysis with a gap of 60£¿mm was confirmed by means of X-ray and MRI. Simultaneously, other pelvic joint injuries could be excluded. Operative treatment by an open reduction and internal plate fixation yielded excellent results. 1. Introduction Rupture of pubic symphysis is an uncommon event after vaginal delivery. Reported incidence varies from 1 in 300 to 1 in 30.000 deliveries [1]. While a mild diastasis of the pubic symphysis (i.e., less than 10£¿mm) is considered to be physiological in pregnancy, greater separation can lead to tenderness of palpation and disability to ambulate [2]. Factors that contribute to a rupture of pubic symphysis are rarely defined. Nevertheless, it seems clear that multiparity, macrosomia accompanied by cephalopelvic disorder, McRoberts maneuver, forceps, maternal connective tissue disorders, prior pelvic trauma, and hyperflected legs may predispose to pubic symphysis diastasis [2¨C4]. Diagnosis can be confirmed rapidly by pelvic X-ray. Additionally, MRI serves to exclude soft tissue injury. However, there is no consensus on the optimal therapy [5, 6]. Typically, a conservative treatment is performed comprising pelvic girdle, analgesia, bed rest in lateral decubitus, and physical therapy [1, 2, 7¨C12]. In cases of extreme pubic symphyseal rupture with pelvic instability or persistent pain after conservative therapy, operative treatment is a successful alternative method, which has been reported in several cases [4, 6, 13¨C15]. 2. Case Report A twenty-year-old gravida 1, para 1 was referred to our tertiary care hospital with immediate pain in pubic symphysis on the first postpartum day. The patient had no previous medical or surgical history. Her antenatal course had been uncomplicated. Three days before term, the
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