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Symphysiolysis with avultion of bladder and urethra After Spontaneous

Vaginal Delivery: Case Report

Indra wijaya putraA!haruddin"#eu$u %anta Aulia&'ufriadi Ismy( )ut meurah yeni*

+, -eneral surgery resident Surgery Department .edi)al /a)ulty of Syiah 0uala 1niversity 2ainoel Abidin -eneral 3ospital4anda A)eh

5, 3ead of 6rthopaedi) surgery division Surgery Department .edi)al /a)ulty of Syiah 0uala 1niversity 2ainoel Abidin -eneral

3ospital 4anda A)eh

7, 6rthopaedi) surgery division Surgery Department .edi)al /a)ulty of Syiah 0uala 1niversity 2ainoel Abidin -eneral

3ospital 4anda A)eh

(, 1rologi) surgery division Surgery Department .edi)al /a)ulty of Syiah 0uala 1niversity 2ainoel Abidin -eneral 3ospital

4anda A)eh

*, /etomaternal division 6bstetri) and gynae)ologi) Department .edi)al /a)ulty of Syiah 0uala 1niversity 2ainoel Abidin

-eneral 3ospital 4anda A)eh

Introdu)tion

The diastasis of the pubic symphysis is an uncommon peripartumcomplication that might become a serious medical condition to the

patient. The incidence of diastasis is from 1 in 300 to 1 in 30,000

deliveries.The incidence of Symphysiolysis with avultion of

bladder and urethra After Spontaneous Vaginal elivery is never

been reported. !n pregnancy, gap between pubic symphysis in range

3 " # mm and is $nown as a physiological pubic diastasis. %igher

widening more 10 mm of pubic symphysis pubis is considered to

be pathological called symphysiolysis

Case Report

A &3'year'old primigravida woman was refered to dr. (ainoel

Abidin )eneral %ospital from *ireun district hospital after & days

spontaneous vaginal delivery and sudden onset of severe pelvic

pain and inability to stand or wal$. +n her physical eamination

there was pain by pelvic compression, local tenderness and gap on

symphysis. -ternal vaginal eamination found Vaginal aceration

with urethral and bladder nec$ avulsion She had no history of

instrumentation or prolonged labour and she has delivered a

newborn baby weighing 3/00 gr with %ead ircumferencial

3cm. +n her radiological eamination pelvis anteroposterior viewrevealed separation of symphysis pubis 2symphysiolysis about

30mm. There were no other bone pathology.. The patient was

anaemic and got blood transfussion. The separation was reduced by

internal pelvic fiation and performed urethral and bladder nec$

reconstruction and Vaginal repair.

Con)lution

4apid descent of fetal head during labour may separate symphysis

pubis at a pregnant who lac$s pelvic fleibility. Symphysiolysis can

be diagnosed from 5hysical and radiologic eamination.

linical Appearance

8re 6perative

8ost 6perative

5elvic 4adiologic6

Symphysiolysis

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onservative or operative procedure can perfomed to treat

symphysiolysis depend on distance of symphisis pubis separation

0eywords: SymphysiolysisAvultion of uretra and bladder

spontaneous delivery

+pen 4eduction !nternal

7iation of symphysis pubis

4econstruction of urethral

and bladder nec$

5elvic 4adiologic post +pen

4eduction !nternal 7iation