Postpartum Pubic Symphysis Diastasis
Pubic symphysis diastasis (PSD) following childbirth via vaginal delivery is a rare but debilitating condition. Widening of the cartilaginous joint during pregnancy before childbirth is physiologic and assists in expanding the birth canal for successful delivery. However, reports of non-physiologic pubic diastasis exceeding that typically required for childbirth (typically greater than 1 cm) can leave mothers with debility and extreme pain. The incidence of complete separation of the pubic symphysis is reported to be within 1 in 300 to 1:30,000, with many instances likely undiagnosed. The orthopedic surgeon is presented with a difficult decision when managing these patients as the women are high-risk surgical candidates in the peri-pregnancy state and prolonged debility can affect their ability to care for their newborn. Discussions of multiple treatment options in the literature include non-operative treatment with application of pelvic binder coupled with physical therapy and immediate weight-bearing, non-weight bearing with bedrest, closed reduction with application of binder, application of anterior external fixator with or without sacroiliac screw fixation, and anterior internal fixation with plate and screws. An interprofessional team approach is essential in both early detection and treatment for satisfactory patient outcomes.
Seidman AJ, Siccardi MA. Postpartum Pubic Symphysis Diastasis. 2021 Jul 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30725728.