Shippey Stuart, Roth Jonathan, Gaines Robert
Department of Obstetrics & Gynecology, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA, 23708, USA,
Int Urogynecol J. 2013 Oct;24(10):1757-9. doi: 10.1007/s00192-013-2120-0. Epub 2013 May 15.
Pubic symphysis diastasis during obstetric delivery occurs rarely. Symptoms usually respond to conservative management. A nulliparous 39-year-old delivered spontaneously with an audible pop noted. Pubic symphysis diastasis of 4.6 cm was diagnosed on pelvic X-ray. She developed severe pain with ambulation and stress urinary incontinence. After neither of these symptoms improved significantly in response to conservative management, the patient underwent open reduction internal fixation with plating of her pubic symphysis, and bladder neck sling placement using autologous rectus fascia. Postoperatively she experienced urinary retention, which resolved with continuous bladder drainage for 1 week. Both her urinary incontinence and pain resolved, and she had resumed normal activities 3 months following her surgery. Pubic symphysis diastasis is a rare obstetric complication with a paucity of literature to guide its management. A coordinated multidisciplinary approach to management is necessary when multiple organ systems are involved.
产科分娩期间耻骨联合分离很少见。症状通常对保守治疗有反应。一名39岁初产妇自然分娩，分娩时听到一声脆响。骨盆X线检查诊断为耻骨联合分离4.6厘米。她出现行走时剧痛和压力性尿失禁。在保守治疗后这些症状均未明显改善，患者接受了耻骨联合切开复位内固定钢板治疗，并使用自体腹直肌筋膜进行膀胱颈悬吊术。术后她出现尿潴留，通过持续膀胱引流1周得以解决。她的尿失禁和疼痛均得到缓解，术后3个月她已恢复正常活动。耻骨联合分离是一种罕见的产科并发症，缺乏指导其治疗的文献。当涉及多个器官系统时，采取协调一致的多学科治疗方法很有必要。
