Traumatic symphyseal rupture by vaginal delivery,report of a rare case

Czech version

Authors: J. Hofierková
Authors‘ workplace: Gynekologicko-porodnické oddělení Nemocnice s poliklinikou, Česká Lípa primář MUDr. M. Volek
Published in: Ceska Gynekol 2016; 81(3): 222-227

Overview

Objective:
This case report draw attention symphysis pubic dysfunction and injury pelvic girdle by vaginal delivary (in our case compliated by dystokia shoulders), mainly its diagnostic, prediction and treatment.

Design:
Case report.

Setting:
Department of Obstetrics and Gynecology. Hospital Česká Lípa.

Case report:
We report a case of a 31 years old woman, who gave birth for the second time with rupture of symphysis after delivery. Childbirth was complited by dystokia shoulders and patient was treated with external fixator.

Conclusion:
Pregnancy is a time of many physiological changes, these changes impact the musculosceletal system, which can develop a variety of problems, such es back pain, separation of the pelvic bones, transient osteoporosis and tendonitis. Effective management of treatment remains difficult to determine because of a variation in reported occurence rates and symptomatology. The most of cases are solved conservatively. This case report is extreme case of birth injury pelvic skeleton and it was necessary for surgery with an external fixator.

This cases should be not to underestimate it and to treat it in interdisciplinary cooperation.

Keywords:
pelvic pain, pregnancy, symphyseal rupture, diastasis of the pubic bone, vaginal delivery complications

Sources

1. Bonnie, L., Bermas, MD., (eds.). Musculoskeletal changes and pain during pregnancy and postpartum. UpToDate, 2016.

2. Čech, E., Hájek, Z., et al. Porodnictví. 2. ed. Praha: Grada, 2006, s. 342–343.

3. Deependra, S., Mayank,V., Akhil, B., et al. Postpartum pubic symphysis disruption following normal full term vaginal delivery: a rare case report. Njmdr, 2014, 3, p. 56–59.

4. Herren, C., Sobottke, R., Dadgar, A., et al. Peripartum pubic symfysis separation – current strategies in diagnosis and therapy and presentation of two cases. Injury. Int J Care Injured, 2015, 46, p. 1074–1080.

5. Jain, S., Eedarapalli, P., Jamjute, P., et al. Symphysis pubis dysfunction: a practical approach to management. Obstet Gynecol, 2006, 8, p. 153–158.

6. Jayaraman, KJ., Ganapathy, P., Nallainnan, I. Post-partum diastasis of the pubic symfysis: Report of a rare case. J Clin Diagnosis Res, 2015, 9, p. 9–10.

7. Jazlan, J., Kwek, K. Symphysis pubis diastasis after normal vaginal birth: a case report. Ann Academy Med, 2007, 36, p. 83–85.

8. Kubínová, K., Kudrna, K., Mašata, J., el al. Spontánní ruptura symfýzy následovaná profuzním krvácením do dutiny břišní během vaginálního porodu. Čes Gynek, 2009,74, s. 64–66.

9. Nitsche, JF., Howell, T. Peripartum pubic symphysis separation: a case report and review of the literature. Obstet Gynecol Surv, 2011, 66, p. 153–158

10. Svelato, A., Ragusa, A., Spinoso, R., et al. Postpartum pubic symphysis diastasis: a case report and review of literature. It J Gynecol Obstet, 2014, 26, p. 25–28.