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Overview :
A pregnant woman's symphysis pubis may separate during late
pregnancy or delivery. It may be due to excessive mechanical loading, effects of
hormones (relaxin) and/or laxity in connective tissue.
The term "pelvic girdle relaxation" may be used if other
ligaments in the pelvic girdle also show significant separation.
Clinical findings:
(1) The
time of separation may be occult or it may with present as a crackling noise or
a bursting sensation.
(2) The
woman experiences pain in the region of the symphysis with point tenderness to
palpation.
(3) Walking
worsens the pain and the patient may develop a waddling gait.
(4) Back
pain may develop or worsen if the separation is wide.
(5)
Bruising, edema or a hematoma may be seen over the symphysis.
(6)
Intercourse may be painful or uncomfortable.
(7) Pain
may recur during ovulation.
(8) The
condition usually resolves. The time may range from a few days in mild caes to
6-8 months when severe.
(9) The
separation may recur on subsequent pregnancies.
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Separation of the Symphysis
Pubis |
Interpretation |
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4-5 mm |
normal distance in nonpregnant woman |
|
7-8 mm |
distance common in pregnant women |
|
8 - 9 mm |
indeterminate |
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>= 1
cm |
abnormal separation |
If there is a family history of the condition and the patient
shows joint laxity then Ehlers-Danlos or other inherited disorder of connective
tissue should be considered.
Complications:
(1) Deep vein thrombosis may develop if the patient undergoes
prolonged bedrest.
(2) Urinary
and/or fecal incontinence may occur if a large hematoma forms.
The differential diagnosis is extensive and includes:
(1) osteomyelitis
(2) scoliosis
(3) rheumatologic disorder
(4) pelvic fracture
(5) herniated intervertebral disc
(6) bone tumor
(7) injury to the urinary bladder
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