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The Journal of Maternal-fetal &... Dec 2004A review of the literature revealed a multitude of terms used to describe Symphysis Pubis Dysfunction (SPD). No unambiguous definition was found, rather the condition is... (Review)
Review
A review of the literature revealed a multitude of terms used to describe Symphysis Pubis Dysfunction (SPD). No unambiguous definition was found, rather the condition is described in terms of symptoms and signs. These occur due to the physiological pelvic ligament relaxation and increased joint mobility seen in pregnancy. The severity of symptoms varies from mild discomfort to severely debilitating pain. There appears to be no correlation between the degree of relaxation of the symphysis pubis and the level of pain and disability. Treatment is generally conservative and delivery is curative in the majority by 6 months post-partum. There is a need for standardisation of terminology, an agreed definition of SPD and a reliable means of assessment of the condition. Additionally there is a need for scientific evaluation of different forms of treatment.
Topics: Female; Humans; Joint Diseases; Pain; Pregnancy; Pregnancy Complications; Pubic Symphysis; Severity of Illness Index; Terminology as Topic
PubMed: 15621554
DOI: 10.1080/14767050400018247 -
The Journal of the American Board of... 1994A severe case of separation of the symphysis pubis during labor and delivery is reported, which included severe pain and unusual complications of urinary outflow... (Review)
Review
A severe case of separation of the symphysis pubis during labor and delivery is reported, which included severe pain and unusual complications of urinary outflow incontinence and fecal incontinence that gradually resolved with conservative treatment. The incidence of symphysis pubis separation is reported to be between 1:600 and 1:3400 obstetric patients. Treatment should generally be conservative and symptomatic. Prognosis for recovery is excellent. Recurrent separation of the symphysis pubis could occur during subsequent deliveries but generally is no worse than the first occurrence. This case report illustrates the unusual complications that can occur with severe diastasis of the symphysis pubis during pregnancy. Family physicians, obstetricians, and orthopedic surgeons could encounter this complication of childbirth in their own practices. Although the symptoms are dramatically severe in presentation, a conservative management approach is effective.
Topics: Adult; Female; Humans; Joint Dislocations; Obstetric Labor Complications; Pregnancy; Pubic Symphysis; Radiography
PubMed: 8184705
DOI: No ID Found -
JNMA; Journal of the Nepal Medical... Dec 2023The pubic symphysis is a midline, non-synovial joint connecting the right and left superior pubic rami. The joint allows very limited movement of approximately 0.5-1 mm....
UNLABELLED
The pubic symphysis is a midline, non-synovial joint connecting the right and left superior pubic rami. The joint allows very limited movement of approximately 0.5-1 mm. Under hormonal stimulation during pregnancy, the widening of the symphysis pubis and sacroiliac joints occurs. Pubic symphysis diastasis is defined as the widening of the pubic joint of >10 mm. It is a rare complication of vaginal childbirth for which no gold standard treatment has been defined. Most cases are treated conservatively. A case of pubic diastasis in a 24-year-old G5P2A2L1 following vaginal delivery is reported. Management consisted of simple conservative treatment, which was sufficient in achieving symptomatic relief.
KEYWORDS
case reports; pelvic pain; pubic symphysis diastasis.
Topics: Pregnancy; Female; Humans; Young Adult; Adult; Pubic Symphysis Diastasis; Pubic Symphysis; Postpartum Period; Delivery, Obstetric; Conservative Treatment
PubMed: 38289751
DOI: 10.31729/jnma.8375 -
Obstetrical & Gynecological Survey Jun 2023Peripartum separation of the pubic symphysis is a rare but potentially severe complication of childbirth, which may lead to prolonged immobilization. Thus, prompt... (Review)
Review
IMPORTANCE
Peripartum separation of the pubic symphysis is a rare but potentially severe complication of childbirth, which may lead to prolonged immobilization. Thus, prompt diagnosis and treatment are paramount.
OBJECTIVE
The purpose of this review is to define peripartum separation of the pubic symphysis and provide a thorough review of its etiology, clinical manifestations, diagnostic imaging techniques, management, and prognosis.
EVIDENCE ACQUISITION
This was a literature review using PubMed and Google Scholar.
RESULTS
Peripartum pubic symphysis separation is defined as disruption of the pubic symphysis joint and ligamentous structures with greater than 1 cm of separation during delivery. Risk factors include fetal macrosomia, nulliparity, and precipitous labor. Patients often present with a sensation of something "giving way" in the pubic symphysis area at the time of delivery, or with severe pain in the pubic symphysis region with attempted mobilization postpartum. In severe cases, associated hematomas, pelvic fractures, sacroiliac joint disruption, and urinary tract injury may be seen. Imaging such as x-ray or ultrasound may be used to confirm the diagnosis. Although most patients recover well with conservative management, orthopedic surgical intervention may be indicated in more severe or unresolved cases.
CONCLUSIONS AND RELEVANCE
Pubic symphysis separation is increasingly identified peripartum due enhanced accessibility and utilization of imaging modalities. It can be debilitating and lead to prolonged immobility postpartum. Therefore, early recognition and diagnosis are important, as this can guide decision-making for management. A multidisciplinary team approach, including coordination with obstetrics, orthopedic surgery, physical therapy, and occupational therapy should be used for early detection and treatment to ensure optimal patient outcomes.
Topics: Pregnancy; Female; Humans; Pubic Symphysis Diastasis; Peripartum Period; Pubic Symphysis; Postpartum Period; Parturition
PubMed: 37322998
DOI: 10.1097/OGX.0000000000001156 -
Der Unfallchirurg May 2016
Review
Topics: Bone Plates; Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Bone; Humans; Pubic Bone; Pubic Symphysis; Rupture; Treatment Outcome
PubMed: 27146806
DOI: 10.1007/s00113-016-0165-5 -
The British Journal of General Practice... Apr 1997
Topics: Back Pain; Female; Humans; Joint Diseases; Locomotion; Pain; Physical Therapy Modalities; Pubic Symphysis
PubMed: 9196977
DOI: No ID Found -
British Journal of Sports Medicine Jan 2011The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options... (Review)
Review
OBJECTIVES
The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence.
METHODS
Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL-were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review.
RESULTS
There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis.
CONCLUSIONS
The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.
Topics: Adolescent; Adult; Anti-Inflammatory Agents; Athletic Injuries; Female; Humans; Male; Osteitis; Osteomyelitis; Physical Therapy Modalities; Pubic Symphysis; Sports; Young Adult
PubMed: 18812419
DOI: 10.1136/bjsm.2008.050989 -
Clinical Radiology Feb 2013The symphysis pubis is demonstrated on many conventional radiographic and cross-sectional examinations and abnormality of the symphysis pubis is a common imaging finding... (Review)
Review
The symphysis pubis is demonstrated on many conventional radiographic and cross-sectional examinations and abnormality of the symphysis pubis is a common imaging finding with numerous possible causes. Many significant disorders that affect the symphysis pubis cause it to appear widened, eroded, or destroyed on imaging studies. It is useful for radiologists to have a working differential diagnosis for these appearances, to use when reporting such studies. This review briefly describes the anatomy of the symphysis pubis and presents examples of the various developmental, inflammatory, infectious, neoplastic, traumatic, and metabolic disorders that may cause it to become widened, eroded, or destroyed. Some disorders have pathognomonic imaging features. Others give rise to similar findings that depend more on overall disease activity, rather than the specific diagnosis itself. In such cases, correlation with clinical and laboratory findings will help narrow the differential diagnosis.
Topics: Adult; Age Factors; Aged; Bone Neoplasms; Child; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteitis; Pubic Symphysis; Pubic Symphysis Diastasis; Risk Assessment; Severity of Illness Index; Sex Factors; Tomography, X-Ray Computed; Young Adult
PubMed: 22748520
DOI: 10.1016/j.crad.2012.03.021 -
Midwives : Official Journal of the... Jul 1996
Topics: Adult; Bandages; Female; Humans; Midwifery; Obstetric Labor Complications; Pain; Postnatal Care; Pregnancy; Pregnancy Complications; Pubic Symphysis
PubMed: 8718241
DOI: No ID Found -
American Journal of Obstetrics and... Jan 2020Without cesarean delivery, obstructed labor can result in maternal and fetal injuries or even death given a disproportion in size between the fetus and the maternal... (Review)
Review
Without cesarean delivery, obstructed labor can result in maternal and fetal injuries or even death given a disproportion in size between the fetus and the maternal birth canal. The precise frequency of obstructed labor is difficult to estimate because of the widespread use of cesarean delivery for indications other than proven cephalopelvic disproportion, but it has been estimated that at least 1 million mothers per year are affected by this disorder worldwide. Why is the fit between the fetus and the maternal pelvis so tight? Why did evolution not lead to a greater safety margin, as in other primates? Here we review current research and suggest new hypotheses on the evolution of human childbirth and pelvic morphology. In 1960, Washburn suggested that this obstetrical dilemma arose because the human pelvis is an evolutionary compromise between two functions, bipedal gait and childbirth. However, recent biomechanical and kinematic studies indicate that pelvic width does not considerably affect the efficiency of bipedal gait and thus is unlikely to have constrained the evolution of a wider birth canal. Instead, bipedalism may have primarily constrained the flexibility of the pubic symphysis during pregnancy, which opens much wider in most mammals with large fetuses than in humans. We argue that the birth canal is mainly constrained by the trade-off between 2 pregnancy-related functions: while a narrow pelvis is disadvantageous for childbirth, it offers better support for the weight exerted by the viscera and the large human fetus during the long gestation period. We discuss the implications of this hypothesis for understanding pelvic floor dysfunction. Furthermore, we propose that selection for a narrow pelvis has also acted in males because of the role of pelvic floor musculature in erectile function. Finally, we review the cliff-edge model of obstetric selection to explain why evolution cannot completely eliminate cephalopelvic disproportion. This model also predicts that the regular application of life-saving cesarean delivery has evolutionarily increased rates of cephalopelvic disproportion already. We address how evolutionary models contribute to understanding and decision making in obstetrics and gynecology as well as in devising health care policies.
Topics: Animals; Biological Evolution; Cephalopelvic Disproportion; Cesarean Section; Female; Gait; Hominidae; Humans; Parturition; Pelvic Bones; Pelvimetry; Pelvis; Pregnancy; Pubic Symphysis; Selection, Genetic
PubMed: 31251927
DOI: 10.1016/j.ajog.2019.06.043