Incidence and risk factors of symptomatic peripartum diastasis of pubic symphysis

Abstract

This study was undertaken to determine incidence, associated risk factors, and clinical outcomes of a diastasis of pubic symphysis. Among 4,151 women, who delivered 4,554 babies at the Department of Obstetrics of Seoul National University Bundang hospital from January 2004 to December 2006, eleven women were diagnosed as having a symptomatic diastasis of pubic symphysis. We estimated the incidence of the diastasis and identified the associated risk factors. To evaluate the pain relief and reduction of diastasis we followed up the 11 diastatic patients. The incidence of the diastasis was 1/385. Primiparity (P = 0.010) and twin gestation (P = 0.016) appeared as risk factors for diastasis by univairable analysis; and twin gestation appeared to be the only risk factor (P = 0.006) by logistic analysis. Two patients were operated due to intractable pain; and the remaining nine patients were treated conservatively. The diastatic gap decreased to less than 1.5 cm by 2 to 6 weeks after the diagnosis and then remained stationary. At a mean follow-up of 22.1 months (range, 12 to 47 months), five of 11 patients had persistent symphysis pubis dysfunction. Diastasis is more frequent than generally acknowledged. Pregnant women with multiple gestations should be informed about the potential risk of pubic symphysis diastasis.

Keywords: Prevalence; Pubic Symphysis Diastasis; Risk Factors.

Fig. 1

Patient 1, a 32-yr-old woman, had a pubic pain after vaginal delivery of twin babies. (A) Her pelvic radiograph shows 4.6 cm separation of the pubic symphysis. (B) At 12-month follow-up, the separation gap decreased to 1.3 cm.

Fig. 2

Patient 6, a 32-yr-old woman, had a pubic pain after vaginal delivery of twin babies. (A) Her pelvic radiograph shows 5.6 cm separation of the pubic symphysis. She underwent an internal fixation using a plate and screws. (B) Pelvic radiograph at 15-month follow-up shows well-reduced pubic symphysis gap.

Fig. 3

Patient 11, a 37-yr-old woman, were diagnosed as having a diastasis of symphysis pubis. She complained a click and instability of symphysis pubis. (A) Her pelvic radiograph using fluoroscopy at 16-month follow-up shows a 1.3 cm separation of the pubic symphysis. (B) Under a lateral compression of pelvis, the separation decreased to 0.8 cm.