Pubic symphysis diastasis in twin pregnancy

Abstract

Pubic symphysis diastasis is a rare pregnancy complication whose exact incidence is still not known, but it is estimated to be in the range of 1:300 to 1:30,000 pregnancies. it is defined as a distance between the two pubic bones or an interpubic gap greater than 10 mm with typical presentation. typical symptoms of diastasis symphysis are pain in the symphyseal region that radiates to the lower back and thighs, waddling gait, painful movement, reduced mobility, and, rarely, urinary retention. in this case report we present a case of antepartum pubic symphysis diastasis diagnosed by palpation during a pelvic exam in a multiparous woman with a twin pregnancy. The patient had an uneventful previous antenatal period; at a routine follow-up she reported symphyseal pain over a longer period with exacerbation in the previous three weeks, in addition to difficulty walking and staying in an upright position. on manual palpation a 10-mm interpubic gap was found and the patient was hospitalized. in view of the twin pregnancy and pubic symphysis diastasis it was decided that a cesarean section was the appropriate mode of delivery. a postoperative pelvic X-ray showed an interpubic gap of 14 mm. With regard to the simplicity and reliability of manual palpation in cases of suspected pubic symphysis diastasis, implementing palpation of the pubis in regular obstetrical practice would enable early recognition, immediate treatment, and a better outcome in the long term. also, as there are no evidence-based guidelines considering antepartum pubic symphysis diastasis and each case is approached individually, a comprehensive investigation of this condition is needed in order to achieve standardization of practice.