A pregnant woman's symphysis pubis may separate during late pregnancy or delivery. It may be due to excessive mechanical loading, effects of hormones (relaxin) and/or laxity in connective tissue.
The term "pelvic girdle relaxation" may be used if other ligaments in the pelvic girdle also show significant separation.
(1) The time of separation may be occult or it may with present as a crackling noise or a bursting sensation.
(2) The woman experiences pain in the region of the symphysis with point tenderness to palpation.
(3) Walking worsens the pain and the patient may develop a waddling gait.
(4) Back pain may develop or worsen if the separation is wide.
(5) Bruising, edema or a hematoma may be seen over the symphysis.
(6) Intercourse may be painful or uncomfortable.
(7) Pain may recur during ovulation.
(8) The condition usually resolves. The time may range from a few days in mild cases to 6-8 months when severe.
(9) The separation may recur on subsequent pregnancies.
Separation of the Symphysis Pubis
normal distance in nonpregnant woman
distance common in pregnant women
8 - 9 mm
>= 1 cm
If there is a family history of the condition and the patient shows joint laxity then Ehlers-Danlos or other inherited disorder of connective tissue should be considered.
(1) Deep vein thrombosis may develop if the patient undergoes prolonged bedrest.
(2) Urinary and/or fecal incontinence may occur if a large hematoma forms.
The differential diagnosis is extensive and includes:
(3) rheumatologic disorder
(4) pelvic fracture
(5) herniated intervertebral disc
(6) bone tumor
(7) injury to the urinary bladder
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Specialty: Obstetrics & Gynecology