Severe postpartum disruption of the pelvic ring: report of two cases and review of the literature

Abstract

Pelvic dislocations are rare during labor, and the treatment is controversial. We report two cases of young women who sustained postpartum disruption of the pelvic ring: one case is an 8.8 cm wide separation of the pubic symphysis with sacroiliac joint disruption underwent surgical stabilization and the second case with 4.0 cm disruption being treated non-operatively. These cases illustrated of importance of accurate diagnosis, careful physical exam, fully informed consent and specific treatment for this condition.

Surgical Stabilization of Postpartum Symphyseal Instability: Two Cases and a Review of the Literature

“…APC I injuries are associated with symphyseal widening <2.5 cm and intact anterior SI ligaments, APC II injuries with symphyseal widening >2.5 cm and intact posterior SI ligaments and APC III injuries with a SI disruption. Even though APC I-like injuries were reported in 7 patients [3,18] and APC III-like injuries in 3 patients [10,20,22], childbirth mainly led to pelvic instabilities comparable to APC II injuries [3,9,11,15,16,17,19,21]. …”

“…Three articles were case series [3,18,21], the rest were reports of single cases [9,10,11,15,16,17,19,20,22,23]. …”

“…Thus, 13 articles [3,9,10,11,15,16,17,18,19,20,21,22,23] met the inclusion criteria and were analyzed in detail (table 1). Three articles were case series [3,18,21], the rest were reports of single cases [9,10,11,15,16,17,19,20,22,23].…”

Diastasis of symphysis pubis and labor: Systematic review

“…Despite the variability in the follow-up of the studies and the conservative interventions, the evolution of SPD tended toward complete resolution of the symptoms. Any conservative method seemed to be clearly related to a quicker evolution of the SPD because several women continued to have symptoms after treatment [8,18,27]. Of these women, six received basic conservative treatment (bed rest in the lateral decubitus position and pelvic girdle), two of whom had to undergo an operation due to their intractable pain; three received physical therapy but the authors did not detail the programs, and four received supervised mobilization.…”

“…The clinical approach to SPD uses conservative methods, although surgical reduction is recommended when the diastasis is greater than 4 cm or patients are required to bear loads quickly after delivery [7][8]. Conservative methods suggest lateral decubitus bed rest, a pelvic girdle, walking aids, and progressive mobilization [9][10], although some clinicians also use pelvic traction [7].…”