August 30, 2009

Parturition-Induced Pubic Diastasis

Anteroposterior view of the pelvis in a recently postpartum woman shows widening of the pubic symphysis > 1 cm (double-headed arrow).

Facts: Parturition-Induced Pubic Diastasis/Pelvic Dislocation
  • There is increased mobility of pubic symphysis and sacroiliac joints during pregnancy because of hormonal change
  • During delivery, a rapid forceful descent of fetal head against the pelvic ring can result in this injury
  • Patients experience immediate pain and audible snap during labor
  • Mostly require conservative treatment with a pelvic binder, lateral recumbency and analgesics. In few cases, surgical fixation is used.

Predisposing Factors
  • Multiparity
  • Forceps assisted delivery, shoulder dystocia
  • Maternal developmental dysplasia of the hip, prior pelvic trauma

  • Separation of pubic symphysis >1 cm
  • If separation >4 cm, usually associated with SI joint disruption
  • Patients may have sacral fractures, lumbosacral plexus injury, bladder/urethral injury

Kharrazi FD, Rodgers WB, Kennedy JG. Parturition-induced pelvic dislocation: a report of four cases. J Orthop Trauma 1997;11:277-281.

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