PUBIC SYMPHYSIS DIASTASIS IN PREGNANCY AND DELIVERY (REVIEW)

• Main Authors: A. L. Petrushin, A. V. Pryaluchina
• Format: Article
• Language: Russian
• Published: Vreden Russian Research Institute of Traumatology and Orthopedics 2018-10-01
• Series: Travmatologiâ i Ortopediâ Rossii
• Subjects: pubic symphysis diastasis; symphysis rupture; postpartum complications; pelvic lesions
• Online Access: https://journal.rniito.org/jour/article/view/1054

Purpose of the study — to generalize and arrange the data published in scientific literature and to present current views on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery. Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences. Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.