Pubis Symphysis diastasis during eutocic delivery in an obese primigravid at Kacyiru District Hospital, Kigali, Rwanda

Abstract

Pubic symphysis diastasis is a rare condition characterized by an abnormal widening of the inter-symphysis joint space exceeding 10 mm, most commonly occurring as a complication of labor and delivery. There is no established gold standard for its management, with treatment ranging from conservative approaches to surgical intervention based on severity and clinical presentation. 

Here, we present the case of a 32-year-old primigravid woman at 39 weeks and 2 days of gestation, who was obese and experienced precipitous labor. The patient reported three days of insidious lumbopelvic pain prior to delivery, which was initially attributed to a urinary infection. Following delivery, she developed acute pain and instability in the anterior pelvic ring, rendering her unable to stand or walk. Radiographic imaging confirmed a severe pubic symphysis diastasis measuring 72.7 mm. 

Management involved surgical intervention with pelvic external fixation performed by an orthopedic team, along with perioperative care that included blood transfusions, analgesics, and antibiotics. The patient demonstrated excellent recovery, with no recurrence of pain and significant functional improvement. She was discharged on postoperative day 33 under a rehabilitation program involving walking exercises and crutch support. 

This case underscores the importance of recognizing risk factors for pubic symphysis diastasis, such as obesity, precipitous labor, and primiparity. It highlights the critical role of early diagnosis and timely surgical management in achieving favorable outcomes, advocating for increased awareness among healthcare providers to prevent delays in treatment.