Case of Natural Reverse Symphysiotomy

Separation of pubic symphysis during delivery is a rare complication resulting in considerable and prolonged morbidity for parturient women. The usual presentation is that of something giving way in the region of the symphysis pubis, unbearable lower abdominal pain or difficulty on moving from side to side or performing any weight bearing activities. There may be disruption of sacro-iliac joint, haemorrhage or urine incontinence in severe cases. Treatment modalities range from conservative management (including analgesics, pelvic binders) to orthopaedic management such as external fixation or open reduction and internal fixation. Since postpartum pain is frequently dismissed as attritubale to labor and childbirth, the diagnosis of pubic symphysis diastasis is often delayed or missed altogether.The incidence of complete separation of the pubic symphysis is reported to be within 1 in 300 to 1:30,000, with many instances likely undiagnosed due to mild symptoms and limited debility in most cases.