Pubic Bone

as L&D RN, I don't see many women prenatally or postpartum BUT....

their MDs DO talk at the desk about interesting cases!

Have heard over the years of several patients who had to wear very tight

special pregnancy girdles to help stabilize their pevis due to relaxation of the

pubic joint!

The patients have a great deal of pain with movement and walking, so the

girdle helps keep the joint from sliding around, being painful.

Personally, the idea of walking around with loose pelvic joints rubbing the

wrong way makes me have sympathy pains!

I have had this during my pregnancies. In my second one, the sudden onset of it was the precursor to my late miscarriage. When I was pushing my first baby out, it hurt there so bad that I truly thought that I was never going to walk again.

It was extremely uncomfortable and lasted for quite a while post-partum.

I feel so sorry for those women who have L & D so tough. I have had 5, all but 1 just an ounce shy of 9 lb. One of them was so easy he almost fell out on his own. These stories make me cringe.

Took care of two women with symphisis pubis dislocation during the last weeks of their pregnancies.

Both were from Indonesia, petit is too much for their height and weight. They were married to Dutch men and both delivered big babies 8-9 pounds per Csection.

Nobody ever took care of patients with this before, we only knew it from the books

Both women had had Vit-D Rachitis in their youth, so that might have been another handicap too.

They had lots of pain!!

several years ago, a resp. therapist i had who delivered a fairly lg. baby(about 8.5 lbs.) had the sep. sym. pub. and needed a walker for several weeks afterward. it's the only time i'd seen it in the past 12 yrs. in ob.

As a women's health nurse practitioner, I've worked a lot in caring for women prenatally and postpartum and have seen several women with separated symphysis pubis. It is uncommon but not rare. There can be degrees of separation. Relaxin begins to relax and weaken the pelvic joints during the first half of pregnancy and reaches a maximum in the 7th month. Return to normal begins after delivery and is complete by the end of 6 months. Rupture of the pubic symphysis occurs in patients with excessive relaxation of the pelvic joints. There is an actual tear of the ligaments connecting the pubic bones. The rupture is usually incomplete and a fibrocartilagenous bridge remains. As others have said, pain is especially notable with walking, usually requiring the woman to use crutches or a walker and a binder. Surgery is rarely indicated.

Precipitating factors include bumultous labor, difficult forcepts extractions, CPD, excessive abduction of the thighs at delivery, and basically any condition that might place sudden and excessive pressure on the pubic symphysis.

Hope this helps.

Gail

Originally posted by GailWHNP

....., excessive abduction of the thighs at delivery, .....

Hope this helps.

Gail

i think someone abducted my thighs and left me with the thighs of an elephant...

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OK Sunnygirl, thanks for the laugh. Now I have to clean my soda off the computer screen but it was worth it! lol

Funny ( well, not so funny but definitely interesting) that you should ask this very question. Last week we had a patient ( who of COURSE was one of our facility nurses) who complained of the same symptomology. Doc (female, by the way) pooh pooh's it...Now comes the delivery and I am that night, assigned to post partum...I go to do vitals and notice when the pt gets up to go to the bathroom , that she is limping and with a gait unsteady enough that I am concerned about leaving. She was horribly uncomfortable and I finally had to bug the doc overnight to increase her pain med to 2 vicodin.. I was so persistant for this poor patient ( who I would not allow to walk down the hallway due to my fear that she might fall), that the next day, just to be rid of me, they called in an orthopod, did a ct scan and diagnosed a separated diastasis ( and I just know I mispelled that)..She had a PT consult and was outfitted with a rolling walker, with a script for a walker at home. Orthopod said it would take anywhere from 6 weeks to several months to get back to normal ( I was going to say up to speed but then had visions of the rolling walker...:) ). She will have a bone scan in 6 months and was advised not to get pregnant, if possible, before it heals. She was horrible uncomfortable and described the pain as you did.....

It was the first time in 14 years of OB that I had seen anything so severe...She would scream when ever she had to move. Walking was terrible. I wouldn't wish this on anyone and I am sick and tired of docs dismissing important symptoms such as these...At least PRETEND to care....