1Department of Obstetrics and Gynecology, Border General Hospital, Melrose, United Kingdom
2Department of Obstetrics and Gynaecology, Royal Infirmary Hospital, Edinburgh, United Kingdom
Introduction: Symphysis pubis diastasis (SPD) following childbirth is a rare but potentially debilitating complication, often characterized by lower abdominal pain and mobility issues. While typically associated with traumatic deliveries or instrumental interventions, spontaneous vaginal delivery (SVD) can also predispose individuals to this condition.
Through detailed clinical description and therapeutic approach, we aim to contribute to the understanding and management of this uncommon yet clinically significant condition.
Case Description: The patient is a 29-year-old female, para 2, who presented on the second day post (SVD) with complaints of intense lower abdominal pain centered around the symphysis pubis area and difficulty in movement. Notably, there were no reported respiratory, urinary, or bowel symptoms, and the patient described normal lochia.
Physical examination revealed a temperature of 38.1°C, heart rate of 112 bpm, and a soft abdomen. Suprpubic oedema, bruising and tenderness.
Diagnostic Assessment: Laboratory investigations, with elevated white blood cell count (WBC) of 17 and CRP levels of 213.
The pelvic X-ray revealed widened pubic symphysis and diastasis, while MRI confirmed diastasis with a presumed hematoma, ruling out osteomyelitis and soft tissue oedema. Additionally, orthopaedic consultation guided subsequent management decisions.
Treatment and Outcome: Upon confirmation of symphysis pubis diastasis (SPD) and associated sepsis, the patient underwent prompt initiation of sepsis protocol, including intravenous clindamycin, ciprofloxacin, and Hartmann’s fluid administration. Additionally, physiotherapy was initiated to address mobility difficulties and facilitate recovery.
By day 3, the patient demonstrated signs of improvement, with reduced diastasis observed on MRI, suggestive of resolving hematoma. Despite persistent mobility issues attributed to an infected symphyseal hematoma, conservative management was pursued, avoiding the need for drainage or surgical intervention.
By day 9, the patient reported pain improvement, and inflammatory markers showed a downward trend, with C-reactive protein levels decreasing to 80.
The patient’s clinical course demonstrated favourable response to antimicrobial therapy and conservative management strategies. Long-term follow-up may be warranted to assess for potential sequelae and optimize rehabilitation outcomes.
Conclusion: MDT including sepsis protocol initiation, orthopaedic consultation, and physiotherapy, facilitated comprehensive assessment and targeted therapeutic interventions. Follow-up assessments demonstrated a favourable response to antimicrobial therapy, with resolution of sepsis and reduction in inflammatory markers. Conservative management of the infected symphyseal hematoma was successful, obviating the need for invasive interventions. However, persistent mobility issues underscore the importance of long-term rehabilitation and monitoring for potential sequelae.
Keywords: Symphysis Pubis Diastasis (SPD); Spontaneous Vaginal Delivery (SVD); C-Reactive Protein
Abeer Ahmed., et al. "Postpartum Symphyseal Separation: A Case Report". EC Gynaecology 13.11 (2024): 01-05.
© 2024 Abeer Ahmed., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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