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.

Role of relaxin in diastasis of the pubic symphysis peripartum

BACKGROUND Separation of the pubic symphysis can occur during the peripartum period.Relaxin(RLX)is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments.However,it is unknown whether RLX is associated with peripartum pubic symphysis separation and if the association is affected by other factors.AIM To study the association between RLX and peripartum pubic symphysis separation and evaluate other factors that might affect this association.METHODS We performed a cross-sectional study of pregnant women between April 2019 and January 2020.Baseline demographic characteristics,including gestational age,weight,neonatal weight,delivery mode and duration of the first and second stages of labor,were recorded.The clinical symptoms were used as a screening index during pregnancy,and the patients with pubic symphysis and inguinal pain were examined by color Doppler ultrasonography to determine whether there was pubic symphysis separation.Serum RLX concentrations were evaluated 1 d after delivery using an enzyme-linked immunosorbent assay,and pubic symphysis separation was diagnosed based on postpartum X-ray examination.We used an independent-sample t test to analyze the association between serum RLX levels and peripartum pubic symphysis separation.Multivariate regression analysis was used to evaluate whether the association between RLX and peripartum pubic symphysis separation was confounded by other factors,and the association between RLX and the severity of pubic symphysis separation was also assessed.We used Pearson correlation analysis to determine the factors related to RLX levels as well as the correlation between the degree of pubic symphysis separation and activities of daily living(ADL)and pain.RESULTS A total of 54 women were enrolled in the study,with 15 exhibiting(observational group)and 39 not exhibiting(control group)peripartum pubic symphysis separation.There were no statistically significant differences in terms of maternal age,gestational age,pre-pregnancy weight,weight gain during pregnancy,delivery modes,or duration of the first or second stages of labor between the 2 groups.We did,however,note a statistically significant difference in serum RLX concentrations and neonatal weight between the observational and control groups(122.3±0.7μg/mL vs 170.4±42.3μg/mL,P<0.05;3676.000±521.725 g vs 3379.487±402.420 g,P<0.05,respectively).Multivariate regression analyses showed that serum RLX level[odds ratio(OR):1.022)and neonatal weight(OR:1.002)were associated with pubic symphysis separation peripartum.The degree of separation of the pubic symphysis was negatively correlated with ADL and positively correlated with pain.There was no statistically significant association between serum RLX levels and the severity of pubic symphysis separation after adjusting for confounding factors.CONCLUSION Serum RLX levels and neonatal weight were associated with the occurrence,but not the severity,of peripartum pubic symphysis separation.

NEW THERAPY FOR PUBIC SYMPHYSIS SEPARATION

A new method for curing the pubic symphsis separation is presented in this paper. The site of the pubic symphysis was injected with 1% lidocain,chymotrypsin,prednisolone;and some peroral drugs were administrated at the same time.And the disease could be cured in a week by using the therapy,with an excellent effect without relapse.

Effects of Chiropractic and Traditional Chinese Medicine in Treating Patients with Acute Postpartum Pubis Symphysis Pelvic Girdle Pain

[Objectives]To analyze and study the effects of chiropractic and traditional Chinese medicine on pain score and functional ambyiation category scale rating in patients with cervical spondylosis.[Methods]41 postpartum patients with acute pubic symphysis pelvic girdle pain were treated by Xiao Huoluodan Granules(orally taking one bag of Xiao Huoluodan Granules 20 g three times daily with 120-150 mL warm water after each meal),and combined with sacroiliac joint manipulation,muscle posture relaxation and muscle energy technique.[Results]After treatment,the pain score(VAS)was decreased and Holden walking function rating was improved(all P<0.001).[Conclusions]Chiropractic and traditional Chinese medicine therapy has a significant effect on the treatment of postpartum acute pubic symphysis pelvic girdle pain,and it can effectively relieve pain,improve postpartum quality of life and prevent postpartum complications.Due to its benefits,it is worthy of clinical promotion and application.

Mid-term follow-up of superior pubic ramus osteotomy in locked symphysis pubis with urethral injury:A case report

A locked pubic ramus body is an unusual variant of lateral compression injury.Till date,there have been only 25 cases reported in the published literature.We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm,with associated urethral injury.When all maneuvers of closed and instrumented reduction failed,we per-formed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus.The osteotomy site was stabilized with a 6-hole recon plate.The patient underwent delayed urethral repair 10 weeks after the index surgery.At 3-year follow-up,the patient has sexual dysfunction especially difficulty in maintaining erection,secondary urethral stricture,heterotopic ossification,and breakage of implants.

Outpatient varicocelectomy performed under local anesthesia

Aim： To report a series of varicocelectomy performed under pure local anesthesia. Methods： From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale （VAS） was used to assess whether the pain level was acceptable. Results： The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % （567/575） of men could go back to work by the end of the first post-operative week and only 8 （1.4 %） men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of （18.5 ± 11.3） mm that was regarded as tolerable. Conclusion： This study has shown varicocelectomy under local anesthesia to be possible, simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.

Predictors of early outcome in unstable pelvic fractures

Objective： To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures. Methods： This study was performed prospectively from January 2009 to June 2011 on 36 consecutive patients admitted to the trauma ward of Postgraduate Institute of Medical Education and Research, Chandigarh, with unstable pelvic injuries. Results： In the present study of 36 patients, 29 were managed surgically. Surgical duration was 2 hours in pa- tients operated on within 1 week and 3.4 hours in those operated on after 1 week. The blood loss was 550 ml when surgery was done after a week, but when done within a week it was 350 ml. The average blood loss through Pfanenstial approach was 360 ml, through posterior approach was 408 ml and through combined approach was 660 ml which was significantly high. Conclusion： Anterior approach to the pelvis would cause significantly more amount of blood loss than poste- rior approach and extemal fixation. Surgical approaches do not have any influence on the surgical duration or the infec- tion rate. The blood loss significantly increases when the surgical time is more than 1 h. The infection rate is not influ- enced by the duration of surgery. Presence or absence of associated injuries to the head, chest or abdomen is the main determinants of patient＇s survival and it greatly influ- ences the duration of hospital stay.

Spontaneous urinary voiding of metallic screws in a patient with symphyseal plating for type II pelvic ring disruption

With rapid advancement in surgical techniques and improvement in implant materials, rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased. Among various modes of implant failure, screw/ plate breakage and loosening are common complications following unstable fixation. Migration of loose screws into the urinary bladder has been reported as an extremely uncommon complication of pubic symphyseal plating. Here we present a case report of a 52-year-old female who pre- sented with asymptomatic passage of screws in her urine following migration into the bladder, 2 years after symphy- seal plating for pubic diastasis in an anteroposterior compression pelvic ring injury.