During pregnancy, increased levels of progesterone and relaxin increase pelvic mobility and promote a physiologic widening
(diastasis) of the pubic symphysis to facilitate vaginal delivery. However, after a traumatic delivery, patients can develop a
symptomatic pubic symphysis diastasis. Risk factors include fetal macrosomia, forceps-assisted vaginal delivery, and multiparity.
Symptomatic pubic symphysis diastasis typically presents with suprapubic pain that radiates to the back, hips, thighs, or legs and is
exacerbated by walking, weight-bearing, or position changes. The diagnosis is made clinically; patients have point tenderness to
palpation over the pubic symphysis and sometimes have a waddling gait Management is typically conservative with supportive care
(eg, pelvic support, physical therapy), and most patients recover within the first 4 weeks postpartum
(Choice A) Epidural abscess, a complication of epidural anesthesia, typically presents with back/spinal pain, fever, and focal
neurologic deficits, none of which are seen this patient.
(Choice 8) Femoral nerve damage can occur during delivery as a result of hyperflexion of the thigh (eg, McRoberts maneuver) It
presents with numbness over the anterior and medial thigh, inability to extend the thigh or flex the hip, and diminished patellar
reflexes, none of which are seen in this patient.
(Choice C) Herniated intervertebral disk presents with back, rather than suprapubic, pain that often radiates down the lower
extremities and with focal neurologic deficits.
(Choice D) Pelvic abscess is a complication of cesarean delivery that typically presents with suprapubic or pelvic pain and a fever
that is unresponsive to antibiotics. This patient had a vaginal delivery and is afebrile.
(Choice F) A retroperitoneal hematoma occurs as a result of injury to branches of the internal iliac artery during delivery. Clinical
manifestations include hemodynamic instability, a palpable mass, and possibly fever. This patient is hemodynamically stable, making
this diagnosis unlikely
(Choice G) Sciatica, a lumbosacral radiculopathy, typically presents with low back or unilateral hip pain that radiates down the lower
extremity. Patients have associated motor and sensory deficits on examination. This patient's intact neurologic examination makes
this diagnosis less likely.
Educational objective:
Pubic symphysis diastasis can occur after a traumatic delivery and presents with radiating suprapubic pain that is exacerbated by
ambulation or weight-bearing Treatment is conservative with supportive care.
Nhận xét
Đăng nhận xét