6533b7d8fe1ef96bd126a46b

RESEARCH PRODUCT

Is x-ray compulsory in pubic symphysis diastasis diagnosis?

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SirWe read with great interest your case of postpartum symphy-sis pubis separation (1). We would like to present a case ofpubic symphysis diastasis that we diagnosed with a differentapproach.A 36-year-old gravida 1 para 0 at 39.6 weeks’ gestation wasadmitted with the onset of spontaneous contraction. After threehours and 18 min she delivered a 3170 g baby without compli-cations.Three hours after delivery, she complained of severe pain inthe symphysis pubic region. On examination, there was localtenderness in that region. We performed an ultrasound exami-nation, which revealed a 15.2-mm gap in the region of the sym-physis pubis (Figure 1), diagnosed as pubic symphysis diastasis.She was given analgesics and advised bed rest. The patient wasdischarged six days after delivery and advised to maintain activeambulation and start physiotherapy. Three months later she wasseen at the outpatient clinic. She was able to walk independentlyand was no longer experiencing any pain.Although the case presented is not particularly impressive inseverity, it still offers the opportunity to inform all cliniciansabout the possibility of diagnosing this condition with the useof the ultrasonography alone. The reported incidence of pubicsymphysis diastasis varies widely in the literature, from 1 in 300to 1 in 30 000 deliveries (2,3). Generally, it is a rare complica-tion and for this reason it is very difficult to perform random-ized controlled trials to compare different diagnostic tools. Thediagnosis is based primarily on clinical findings. The most con-sistent finding is pain in the symphyseal region that radiates tothe lower back and thighs and is exacerbated by leg movement(4). In addition, many women will have difficulty walking, infact the gait is described as waddling, or potentially be unableto stand or walk due to pain (3). Symptoms may be noted dur-ing labor and up to 48 h postpartum. Often the first diagnostictest used to identify the pubic diastasis is antero-posterior radi-ography. However, we think that ultrasound might be a goodchoice as an initial imaging study, rather than x–ray, due toabsence of exposure to ionizing radiation and its ease of opera-tion, and as it presents an optimal assessment of the extent ofsymphysis separation (3–5). We performed ultrasonography inthe following way: we placed the probe in transverse orientationon the pubic symphysis (identified by palpation) with an approx-imately 30° caudal scanning plane, with the purpose of measuringthe width of the symphyseal joint at its upper margin.Pubic symphysis diastasis is an uncommon injury that shouldbe considered when evaluating patients in the peripartum periodwho are experiencing suprapubic, sacroiliac or thigh pain. In addi-tion we would like to bring to the general attention the usefulnessof ultrasound in the diagnosis and management of this rare condi-tion. The literature is inconsistent on this topic, due to the lack ofrandomized controlled trials, but good suggestions are present (3–5). In our experience, ultrasound is simple, reproducible and with-out side effects, and should be used as an initial imaging studybecause the accuracy is at least as good as that of x-rays for esti-mating the width of the symphysis pubis diastasis.Alessandro Svelato