International Journal of Clinical Case Reports 2017, Vol.7, No.14, 58-61
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The paraclinic diagnosis is based on radiology of the frontal pelvis showing an inter-symphyseal space greater
than 10 mm (Scicluna et al., 2004), this space was evaluated at 16 mm in the case of our patient. The degree of
separation observed does not appear to be correlated with the severity of the symptoms (Snow and Neubert, 1997)
and a symptomatology remains possible even in the absence of radiological signs (Culligan et al., 2002), some
authors proposed the ultrasound as diagnostic means in particular during of pregnancy where a standard X-ray is
not authorized, but conclude that the examination is not predictive (Scriven et al., 1995).
The treatment modalities include rest, analgesics and anti-inflammatories, local infiltration, physiotherapy,
osteopathy, physiotherapy, even pelvic bandage and surgical treatment with fixation in case of significant diastasis
greater than 4 cm (Kharrazi et al., 1997), preventive anticoagulation is necessary in case of prolonged
immobilization.
In the course of pregnancy, according to some authors (Scicluna et al., 2004), the failure of a local infiltration
proposed could justify the implementation of an epidural analgesia. In postpartum, local infiltration in the pubic
symphysis appears effective. According to the recommendations, it must be performed in the operating room
under strict aseptic conditions and use a solution associating a local anesthetic with a corticoid (Kharrazi et al.,
1997). In our case, it was a symptomatology appeared in immediate postpartum with radiological signs. The
conservative medical treatment combining discharge, analgesics and preventive anticoagulation allowed a
favorable development with improved pain.
The recovery time of pelvic pain syndromes related to pregnancy is less than one month in 62.5% of cases, with
complete disappearance of the isolated pains of the pubic symphysis within six months (Mogren, 2008).
For the prognosis of subsequent pregnancy, there is little evidence for the importance of a preventive caesarean
section in the event of a history of pubic disjunction (Snow and Neubert, 1997).The risk factors for recurrence
mentioned in the articles are fetal macrosomia, multiparty, extraction maneuvers, rapid expulsion, shoulder
dystocia, twinning and trauma of the pubic joint (Culligan et al., 2002).In reality the problem of the traumatic
experience in the postpartum and maternal anguish of recidivism are at the origin of the discussion of the mode of
delivery between the patient and the obstetric team. It is a question of balancing the risks of recidivism, poorly
established, uncertain and the possible complications of caesarean section.
3 Conclusions
The risk factors and pathophysiological mechanisms of pubic disjunction remain unclear, with a risk of recurrence
difficult to establish, but its diagnosis must be evoked before any pelvic pain in pregnancy and postpartum,
confirmed easily by radiology of the pelvis face, a fast and adapted support is essential.
Authors’ contributions
R.H: Editing and supervision,
read and approved the final manuscript
; D.A: participated in the drafting of the observation,
read and
approved the final manuscript;
B.N: participated in the drafting of the discussion,
read and approved the final manuscript;
A.A:
checking references.
All authors read and approved the final manuscript.
Acknowledgments
We thank the radiology department of Ibn El Jazzar Hospital, Kairouan.
References
Albert H., Godskesen M., and Westergaard J., 2001, Prognosis in four syndromesof pregnancy-related pelvic pain, Acta Obstet Gynecol Scand, 80(6):505-10
PMid:11380285
Culligan P., Hill S., and Heit M., 2002, Rupture of the symphysis pubis during vaginal delivery followed by two subsequent uneventful pregnancies, Obstet
Gynecol, 100(5 Pt 2):1114-7
PMid:12423827
