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SYMPHYSIS PUBIS DIASTASIS PRESENTING AS POST-LABOR EPIDURAL PAIN: A CASE REPORT
Author(s): ,
Tay, Y.C.
Affiliations:
Singapore General Hospital, Department of Anaesthesiology, Singapore, Singapore
Tan, C.L.*
Affiliations:
Singapore General Hospital, Department of Anaesthesiology, Singapore, Singapore
ESRA Academy. Tan C. Sep 13, 2017; 190710
Chun Lei Tan
Chun Lei Tan

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Abstract
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Background and Aims:
Symphysis pubis diastasis complicates 1:300 to 1:30000 pregnancies. Peripartum pain in chronological sequence with epidural labor analgesia often attracts instinctive causation and distress. Predisposing risk factors include macrosomia, short second stage of labour, forceps use, multiparity, small pelvis, intense uterine contractions, previous pelvic ring pathology and trauma. This case report aims to discuss symphysis pubis diastasis as a cause of acute pain in a parturient patient.

Methods:

We present a gestational diabetic primigravid parturient with distressing acute back pain after delivery of a macrosomic baby. She had an uneventful, analgesic labour epidural and presented postpartum with intense hammer-like back pain over the right paravertebral L5 and S1 region with no radicular symptoms. Her pain worsened with positional change from sitting to standing and supine to sitting position, although there was no pain at rest. Her severe pain on movement was accompanied by urinary incontinence on several occasions precluding child care.

Results:

Immediate acute pain team review ruled out a central neuraxial cause with epidural and lumbar spine imaging, which revealed a 38mm symphysis pubis diastasis. A pelvic binder was added following Orthopaedic review which aided physiotherapy and ambulation.
Below are the initial, 2 month, and 3 month follow up X-rays of the lumbar spine: 
 

Conclusions:

Symphysis pubic diastasis is usually conservatively managed, unless separation exceeds 5cm where early surgery may improve functional outcomes. Although symptoms may recur in subsequent pregnancies, it does not preclude vaginal delivery. Early recognition and prompt management aim to reduce parturient morbidity and promote resumption of activity.

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