title: Peripartum pubic symphysis separation--Current strategies in diagnosis and therapy and presentation of two cases.
abstract: BACKGROUND
  During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation.
  
  
  METHODS
  This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered.
  
  
  RESULTS
  Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48 h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions.
  
  
  CONCLUSIONS
  Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.
authors: University Clinic RWTH Aachen, Department of Trauma and Reconstructive Surgery, Pauwelsstraße 30, 52074 Aachen, Germany. Electronic address: cherren@ukaachen.de.
authors: C
authors: C
authors: Herren
authors: Medical Center of the City/Region Aachen GmbH, Center for Orthopedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany.
authors: R
authors: R
authors: Sobottke
authors: University of Oklahoma-Tulsa, Department of Orthopedics, 2424 E 21st Street Suite 320, Tulsa, 74113 OK, United States.
authors: A
authors: A
authors: Dadgar
authors: Medical Center of the City/Region Aachen GmbH, Center for Orthopedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany.
authors: M J
authors: MJ
authors: Ringe
authors: Medical Center of the City/Region Aachen GmbH, Center for Orthopedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany.
authors: M
authors: M
authors: Graf
authors: University Hospital Cologne, Clinic and Polyclinic for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Köln, Germany.
authors: K
authors: K
authors: Keller
authors: University Hospital Cologne, Clinic and Polyclinic for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Köln, Germany.
authors: P
authors: P
authors: Eysel
authors: University Hospital Cologne, Clinic and Polyclinic for Obstetrics and Gynecology, Kerpener Str. 62, 50937 Köln, Germany.
authors: P
authors: P
authors: Mallmann
authors: University Hospital Cologne, Clinic and Polyclinic for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Köln, Germany.
authors: J
authors: J
authors: Siewe
mesh_terms: D000328:Adult; D001863:Bone Screws; D036861:Delivery, Obstetric; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D058725:Peripartum Period; D011247:Pregnancy; D011631:Pubic Symphysis / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D046548:Pubic Symphysis Diastasis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Postpartum; Pregnancy; Pubic symphyseal separation; Strategies; Therapy