Title : Postpartum pubic symphysis diastasis: A case report
Abstract:
This case describes a 25-year-old African American woman (G1P0) with a medical history including a prior brain arteriovenous malformation (AVM) repair, pneumonia, and a urinary tract infection, who was admitted at 39 weeks gestation for labor and delivery. She underwent a spontaneous vaginal delivery of a healthy 4.025 kg female infant without immediate complications.
In the immediate postpartum period, the patient began experiencing severe pelvic pain and difficulty walking. Initially, her symptoms were managed conservatively however, due to persistent pain and impaired mobility, there was suspicious for a further diagnosis. Upon further evaluation a diagnosis of postpartum pubic symphysis diastasis (PSD) was made. This is a rare condition characterized by excessive separation of the pubic symphysis. The patient received a steroid injection directly into the pubic symphysis joint. She showed some improvement and was discharged on postpartum day eight.
Within 24 hours of discharge, the patient returned to the emergency department with worsening pelvic pain and an inability to ambulate. This episode was managed with intravenous narcotics and non-steroidal anti-inflammatory drugs (NSAIDs), which led to rapid symptom relief. She was monitored and subsequently discharged again after reporting significant improvement. Five days later at a follow-up visit, the patient still reported mild tenderness over the pubic symphysis but showed significant clinical improvement, including the resolution of her antalgic gait and the ability to urinate and walk. Since the patient was reassured that her symptoms were likely to resolve entirely within three to four months and that is consistent with the natural course of PSD, there was no further imaging done on the patient.
This case highlights the importance of recognizing and appropriately managing postpartum pubic symphysis diastasis (PSD). Increased clinical awareness of this condition would allow providers to consider PSD more readily in the differential diagnosis of postpartum patients presenting with severe pelvic pain and impaired mobility. Early recognition can lead to prompt and accurate treatment, ultimately reducing unnecessary suffering and improving patient outcomes.
