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from Section 7 - Postpartum
Published online by Cambridge University Press: 08 April 2025
Pubic symphyseal separation, or diastasis, is a rare complication, with incidence reported between 1 in 300 and 1 in 30,000 pregnancies. The disorder typically presents with severe pubic pain immediately postpartum and is diagnosed with X-ray, confirming a gap in the pubic symphysis >10 mm. Treatment is aimed at pelvic stability and is initially conservative with a pelvic brace, physical therapy, walking aids, analgesics, and ice packs. The majority of patients experience improvement of pubic symphyseal separation within 6 weeks but it can take up to 6 months. Surgical management by orthopedic surgery is generally reserved for severe cases with diastasis >25 mm or for cases where conservative management failed. Recurrence can be as high as 68–85% in subsequent pregnancies. Previous pubic symphyseal separation is not necessarily an indication for cesarean section in future pregnancies, and planned delivery route should be individualized through shared decision-making.
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