Division of Maternal Fetal Medicine, Department of OB/GYN, Mayo Clinic College of Medicine, Rochester, MN 55901, USA.
Obstet Gynecol Surv. 2011 Mar;66(3):153-8. doi: 10.1097/OGX.0b013e31821f84d9.
Although peripartum pubic symphysis diastasis is an uncommon complication of delivery, it can lead to considerable and sometimes long-term disability. Although the initial clinical examination and diagnostic workup for this complication are relatively straightforward, the best treatment for a peripartum pubic symphysis diastasis is less clear. Historically, nearly all women were treated conservatively with bed rest and pelvic binders. However, more recent case reports have described more invasive orthopedic procedures being used to help speedy recovery. In this study, we present a case of a 22-year-old primigravida who had a severe pubic symphysis separation after a vaginal delivery complicated by a shoulder dystocia. We also reviewed the literature on this topic over the past 20 years to gain a better understanding of the clinical factors surrounding peripartum pubic symphysis separation and the treatment option available to women with this complication.
Obstetricians & Gynecologists.
After completing this CME activity, physicians should be better able to identify the clinical factors that associated with peripartum pubic symphysis separation; perform a diagnostic workup when a peripartum pubic symphysis separation is suspected; distinguish the conservative and invasive orthopedic interventions available for the treatment of peripartum pubic symphysis separation; and show that the degree of patient disability after peripartum pubic symphysis separation varies greatly and no clinical factors or diagnostic studies effectively predict the course of patient recovery.
虽然围产期耻骨联合分离是分娩的一种罕见并发症，但它可导致相当大且有时是长期的残疾。尽管对这种并发症的初始临床检查和诊断性检查相对简单，但围产期耻骨联合分离的最佳治疗方法尚不清楚。历史上，几乎所有女性都采用卧床休息和骨盆束带进行保守治疗。然而，最近的病例报告描述了更具侵入性的矫形手术被用于帮助快速康复。在这项研究中，我们介绍了一位 22 岁初产妇的病例，她在阴道分娩中发生肩难产，耻骨联合严重分离。我们还回顾了过去 20 年来关于这个主题的文献，以更好地了解围产期耻骨联合分离的临床相关因素和患有这种并发症的女性的治疗选择。
妇产科医师。
完成这个 CME 活动后，医生应该能够更好地识别与围产期耻骨联合分离相关的临床因素；当怀疑发生围产期耻骨联合分离时进行诊断性检查；区分保守和侵入性矫形干预措施，用于治疗围产期耻骨联合分离；并表明围产期耻骨联合分离后患者的残疾程度差异很大，没有临床因素或诊断研究能有效地预测患者康复的过程。
