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Sonographic Diagnosis of Pregnancy-associated Symphysis Pubis Diastasis
Hian Yan Voon1,2 MD; Abigail Jerip1,2 MD; Mohamad Adam Bujang3; Andy Bong1,2 MD; Mardiana Kipli1,2 MD; Rafaie Amin1,2 MD
Obstetrics & Gynaecology, Sarawak General Hospital, Malaysia1; Obstetrics & Gynaecology, Universiti Malaysia Sarawak, Malaysia2;
Sarawak General Hospital, Centre for Clinical Research, Malaysia3
Symphysis pubis diastasis occurs in approximately 1:300-1:30,000
pregnancies, presenting with a wide-spectrum of severity ranging
from mild discomfort to severe, debilitating pain. As a result, the
clinician has to contend with several differential diagnoses ranging
from lower urinary tract infection, caesarean scar tenderness to
preterm labour. In the non-obstetric population, pelvic radiographs
are widely used to aid diagnosis although this may result in
increasing alarm and anxiety to the pregnant mother.
We sought to establish the feasibility of using ultrasound in
measurement of the symphysis pubis gap (SPG) in symptomatic
This was a pilot prospective case-controlled study to evaluate the
symphysis pubis gap in symptomatic women during the peripartum
period, conducted between March-September 2017. A total of 20
patients were assessed and cases were matched for gestational
age, parity, body mass index and previous vaginal birth. Mode of
delivery was also controlled for in postpartum patients. The case to
control ratio was 1:4.
Sonography was performed with women in supine position, using a
5 MHz curvilinear transducer in a transverse scanning plane. Two
designated operators performed the scan using either Voluson E6
or Philips HD15. SPG was measured at the narrowest point of
upper margin of the symphysis pubis joint. Three consecutive
measurements were recorded and the average taken. Effect size of
measurements were estimated using partial eta squared.
The mean SPG amongst symptomatic postnatal women (n=3)
compared to matched-controls (n=12) were 14.5mm vs 8.8 ±1.5
(effect size 0.79), 10.1mm vs 5.9 ±1.2 (effect size 0.76) and 7.6mm
vs 6.0 ±0.7 (effect size 0.58) respectively.
Only one antenatal patient had symptoms suggestive of symphysis
pubis diastasis during the study period, presenting at 33weeks of
gestation. The SPG was 17.0mm compared to 5.7 ±1.0 in controls
(effect size 0.971).
Both antenatal and postnatal women with symphysis pubic
diastasis had wider SPG when controlled for gestational age, parity,
body mass index, previous vaginal birth and mode of delivery. The
effect size measured was large in all cases and moderate in one,
reflecting the potential usefulness of sonography. Larger studies are
required to determine if a threshold value could be reliably used to
establish a diagnosis.
Panoramic view of a normal symphysis pubis gap Widened symphysis pubis gap in a symptomatic patient
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