[Two cases of postpartum pubis diastasis mistaken for neurological complications of epidural analgesia].
Two healthy 31- and 34-year-old parturients received uncomplicated epidural analgesia for labor and delivery using standard techniques. Twenty-four and 12 hours postpartum, respectively, they developed severe lower back pain and difficulty moving their lower extremities. At first the symptoms were attributed to neurological complications of epidural analgesia and for this reason the anesthetist was called. Although both women appeared healthy and the neurological examinations were normal, emergency computed tomography scans were performed to rule out spinal compression because of the severity of pain and difficulty of movement. The diagnosis was only established after suspecting pubis diastasis, confirmed by palpation of symphysis gaps of 3 and 2 cm, respectively. Pelvic dysfunction associated with pregnancy and labour is a complication whose incidence varies from 1 in 300 to 1 in 30,000. It presents with severe pain located in the areas supplied by pudendal and genitofemoral nerves. The pain may radiate to the sacroiliac joints and shoot down the buttocks and legs. In the most severe cases it may be accompanied by urinary dysfunction and inability to walk. If the clinical features are not recognized, it can be difficult to differentiate pubis diastasis from severe neurological complications in women who have received a central nervous system block. We report two cases of peripartum pubis symphysis diastasis that were both initially mistaken for neurological complications of epidural analgesia for labor.
Moral Turiel
M
M
Hospital Universitario "12 de Octubre", Centro Materno Infantil, Madrid. mercemoral@terra.es
Ruiz Abascal
R
R
Alonso Mateos
M
M
Márquez Garrido
G
G
Odriozola Feu
J M
JM
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D009422:Nervous System Diseases / Q000139:chemically induced / Q000175:diagnosis*; D046548:Pubic Symphysis Diastasis / Q000175:diagnosis*