title: Symphysis pubis separation during vaginal delivery with epidural anesthesia. Case report.
abstract: OBJECTIVE
  Peripartum pubic separation (diastasis pubis) is an uncommon event with a reported incidence varying between one in 521 to one in 30,000 deliveries. The injury is caused by the fetal head exerting pressure on pelvic ligaments that have been weakened or relaxed by the hormones progesterone and relaxin. Diastasis pubis has been previously reported in both obstetric and orthopedic literature. However, the authors have been unable to locate any discussion of this condition in the anesthetic literature. Historically, symphyseal separation has been frequently unrecognized. The authors present the case of a nulliparous woman who suffered a diastasis pubis during assisted vaginal delivery under epidural anesthesia.
  
  
  METHODS
  Epidural catheter placement and administration of medications were performed using standard techniques described.
  
  
  RESULTS
  The patient had an episode of breakthrough pain during labor despite adequate epidural analgesia and experienced postoperative pubic and thigh pain secondary to pubic separation.
  
  
  CONCLUSIONS
  Diastasis pubis is an uncommon injury that should be considered when evaluating patients in the peripartum period who are experiencing suprapubic, sacroiliac, or thigh pain.
authors.affiliation: Department of Anesthesia and Critical Care, Beth Israel Hospital, Springfield, Massachusetts.
authors.forename: R
authors.initials: R
authors.lastname: Musumeci
authors.forename: E
authors.initials: E
authors.lastname: Villa
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D010149:Postoperative Pain; D011247:Pregnancy; D011631:Pubic Symphysis / Q000293:injuries*