International Journal of Clinical Case Reports 2017, Vol.7, No.14, 58-61
58
Research Report Open Access
Symphyseal Disjunction Syndrome after an Obstructed Labor
Ragmoun Houssem
1
, Daadoucha Abdrahmen
2
, Benhlima Najeh
3
, Ajili Abir
1
1 Department of Obstetric Gynecology Ibn El Jazzar Hospital, University hospital assistant in gynecology obstetrics, Ibn El Jazzar street, Kairouan, 3100,
Tunisia
2 Department of Radiology Ibn El Jazzar Hospital, University hospital assistant in radiology, Ibn El Jazzar street, Kairouan, 3100, Tunisia
3 Department of Cardiology Ibn El Jazzar Hospital, University hospital assistant in cardiology, Ibn El Jazzar street, Kairouan, 3100, Tunisia
Corresponding author email
International Journal of Clinical Case Reports 2017, Vol.7, No.14 doi
Received: 17 Aug., 2017
Accepted: 24 Oct., 2017
Published: 27 Oct., 2017
Copyright © 2017
Ragmoun et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Ragmoun H., Daadoucha A., Benhlima N., and Ajili A., 2017, Symphyseal disjunction syndrome after an obstructed labor, International Journal of Clinical
Case Reports, 7(14): 58-61 (doi
Abstract
The symphysis disjunction diagnosed is a rare disease, which is defined by a radiologically enlargement at the
inter-symphyseal articulation estimated greater than 10 mm. Yet its repercussions in daily practice are from stakeholders undervalued.
This condition requires specialized care in the event of severe and disabling pain. We report the case of a patient with severe pelvic pain
with impotence the right lower member J2 childbirth by forceps, clinical examination objectified exquisite tenderness of the symphysis
pubis. The diagnosis was confirmed by an X-ray of the pelvis objectifying a widening of the symphysis pubis 16 mm, the therapeutic
management consisted of turning on landfill and preventive anticoagulation with an analgesic treatment with paracetamol and NSAIDs.
The outcome was favorable.
Keywords
Symphyseal disjunction; Obstructed labor
Background
The symphysis disjunction syndrome is an under-evaluated and poorly treated pathology, diagnosed mainly in the
post-partum period, which can be responsible for significant morbidity. A rapid and adapted management is
essential. Its diagnosis is evoked clinically before insidious pains occurring in the pregnant woman or brutally in
postpartum and can be confirmed by radiology of pelvis face. We report the observation of a patient with
symphysis disjunction syndrome following a delivery with instrumental extraction.
1 Observation
Mrs. MR, aged 35, fourth pregnancy gesture, and the current pregnancy was followed by a midwife, apparently
normal course, notably no notion of pelvic pain or other dysgravidia, carried to term, the patient was sent to us
from a peripheral maternity for lack of expulsion.
On examination, the patient was conscious with correct arterial tension, obstetrical examination objectivized an
engaged cephalic presentation, fetal heart sounds were present, instrumental extraction by forceps was performed
with customary precautions allowing extraction of a live baby weighing 4 400 grams, perineal repair occurred
without special problems and the postpartum examination was normal. On the second day postpartum, the patient
presented severe abdomino-pelvic pain without special irradiation with impotence of the right lower limb as well
as bladder retention; clinical examination showed a greater abdomino-pelvic sensitivity to palpation of the pubic
symphysis. The radiology of the frontal pelvis (Figure 1) showed an enlargement of the symphyseal space of 16
mm, therapeutic management was preventive discharge and anti-coagulation with analgesic treatment based on
paracetamol and nonsteroidal anti-inflammatory. The outcome was marked by a decrease in pain as well as an
improvement in the lower limb impotence, and the resumption of a spontaneous diuresis, it was declared outgoing
on day 14 postpartum. Controls showed a decrease in pubalgia but walking difficulties and positron pains sat, a
reprise of professional activities was allowed at eight months postpartum with complete disappearance of clinical
genes.
