Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature

BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging from 1 in 300 to 1 in 30000 pregnancies),no gold standard treatment has been defined.CASE SUMMARY This study examines two cases,a 27-year-old woman(gravida 1,para 1)and a 32-year-old woman(gravida 2,para 2),who presented to the clinic after uneventful vaginal deliveries.A normal pregnancy with no complications was observed in both patients.Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion.Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended.Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations.The symptoms decreased after treatment.Posttreatment magnetic resonance imaging(MRI)in the first case showed a reduction in symphyseal separation with no signs of osteitis.Three years later the symptoms recurred;MRI examination showed no further symphyseal widening or signs of osteitis.A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery.In the second case,pain recurred when the patient conceived for the second time.This time no benefit following conservative treatment was observed.Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy,thus surgical treatment was chosen and internal pubic synthesis was performed.CONCLUSION Overall,surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.

Is Postpartum Uterine Involution Impacted by Instrumental or Operative Procedures? Ultrasound Study

Objectives: Practitioners are continuously concerned with the differences between the normal puerperium and the uterine involution after operated deliveries. This prospective observational study pays attention to the uterine involution period after the instrumental or operative delivery and compares the results with those observed in uncomplicated labour. Methods: Over two postpartum months 66 women after normal (48) and complicated (18) labour were examined for repeated uterine parameters. The analysis was performed using SPSS version 21. Results: There was no statistically significant difference between the median uterine size parameters or the uterine artery indices after the normal delivery and instrumental/operative uterine manipulations during the involution period, except for a faster declining trend observed in anteroposterior diameter within the first month after normal labour. The diastolic notch was more frequent in early puerperium after complicated labor, but less frequent later. The diastolic notch did not appear in all the postpartum women even two months after labour. There was evidence of more frequent gas detected in the pathological rather than in the physiological group. Conclusion: Postpartum uterine involution is not impacted by instrumental or operative procedures. After complicated labour gas appearance is more common, but it does not necessarily indicate the presence of endometritis or retained placental tissues.