Antepartum Pubic Symphysis Diastasis -A Diagnostic Challenge?

Abstract

Widening of the symphysis pubis is a physiological mechanism for vaginal delivery. Hormonal and physiologic influences of pregnancy, mostly due to relaxin cause a two-fold increase from the normal width. A 31-year-old G2A1, developed pain over the pubis along with difficulty in walking from 20 weeks of gestation. The pain initially, was on getting up from bed. It worsened with gestation and was not relieved with analgesics. Again, a 29-year-old G2L1, developed pain over the pubis from 31 weeks of gestation. She had difficulty in turning in bed as well as walking. Both patients were diagnosed with antepartum symphysis pubis diastasis and was confirmed with Xray pelvis postpartum. The risk factors are multiparty, macrosomia, cephalopelvic disproportion, forceps delivery, connective tissue disorders, malpresentation, prior pelvic trauma, intense uterine contractions, abnormally long or short duration of labour, shoulder dystocia, Mc Roberts manoeuvre and epidural anaesthesia. MRI aids in antepartum diagnosis and planning mode of delivery, but is not cost effective in low resource settings. Hence a conservative approach is essential for satisfactory patient outcomes and confirmation of the condition can be carried out postnatally.