Pubic disjunction following vaginal delivery in a multiparous woman: A case report

INTRODUCTION: Pubic disjunction syndrome has been identified as responsible for pain during pregnancy and post partum; it is favored by twins and traumatic events such as extraction maneuvers. CASE REPORT: A 38-year-old woman, 5G/5P, with no pathological history, who presented 2 days postpartum with no notion of instrumental extraction, with severe pelvic symphysis pain with functional impotence. Examination revealed elective pain on palpation of the pubic symphysis without radiation. X-ray of the pelvis showed a 15-mm enlargement of the symphysis. CT scan of the pelvis showed a 17-mm disjunction of the pubic symphysis. The patient received analgesic treatment with pelvic bandage and anticoagulant therapy with good clinical response. DISCUSSION: Peripartum pubic disjunction is a rare entity whose etiologies are still poorly understood, although multiparity, fetal macrosomia, extraction maneuvers, and joint pathologies have been incriminated. Symptomatology includes pubic symphysis pain. Conventional radiology shows an abnormal space at the inter-symphysial joint greater than 10 mm. Medical treatment with pelvic bandage, rest, physical therapy and physiotherapy allows a favorable evolution, otherwise infiltrations containing a local anesthetic and corticosteroids. Surgery is indicated if the diastasis is greater than 4 cm. CONCLUSION: Symphyseal disjunction is evoked in front of any pelvic pain in peripartum, the diagnosis is made at the radiology of the pelvis with intersymphysis space higher than 10 mm. The treatment is medical associating an analgesia or a local infiltration, a rest and a physiotherapy. Pelvic bandaging and surgical treatment are reserved for complicated forms.