Postpartum Pubic Symphysis Separation Managed with Comprehensive Inpatient Rehabilitation
A 28-year-old female presented to inpatient rehabilitation for severe pelvic and groin pain during her postpartum period. Nine days prior to presentation, the patient had a spontaneous vaginal which lasted 3 hours and reported pelvic pain with ambulation shortly afterwards. X-ray series of the pelvis revealed a 5.6 cm widening of the pubic symphysis consistent with severe postpartum pubic symphysis diastases. Orthopedics recommended nonoperative management, weight bearing as tolerated, and a pelvic binder. The patient progressed well in her rehabilitation program. Follow up imaging of the pelvis showed diastasis decrease to 2 cm wide.
The incidence of postpartum diastasis is rare and varies from 1:300 to 1:30000. In this case, the main focus of care is pain management and rehab care without interfering with breast feeding. Dilaudid and other physical modalities were safe and well tolerated in this breast feeding mother. However, most literature advocate for surgical management if separation > 4 cm, this case approved that a comprehensive inpatient rehabilitation is an effective management for separation up to 5.6 cm. Patient's FIM score improved from 59 to 88 and gait also improved from 2ft to 150ft during inpatient rehabilitation. In summery, rehabilitation care has not only helped to reduce the pain and improve the function but also to reduce the pubic symphysis separation by more than 3.5 cm, and facilitated her to return to normal activities.
This case report is significant because it reflects the integral role of inpatient rehabilitation in the conservative management of postpartum pubic symphysis diastasis up to 5.6 cm. Family education and Inter-professional communication between obstetric, orthopedic and rehabilitation team enhances best outcome and reduces chronic complications.
Hashem Zokary– PMR resident, Beaumont Hospital Taylor
Alexandre Mazar– PMR resident, Beaumot Hospital-Taylor
Manasa Vasireddy– Research Assistant, Beaumont Hosptial-Taylor Physical Medicine & Rehabilitation
Johnathan Ho– Faculty, Beaumont Hospital Taylor- PMR
P. Tyler Roskos– Clinical Neuropsychologist, Beaumont-Hospital Taylor Physical Medicine and Rehabilitation
Melissa Kawa– Faculty, Beaumont Hospital-Taylor