Pubic symphysis. Divergence of the pubic symphysis during pregnancy. Stretching and tearing of the joints of the pelvis: symptoms and principles of treatment

Nature has wisely created the female body so that it can fully ensure the bearing and birth of a child. The female pelvis differs in structure from the male: it is lower, wider, its bones are thinner, and the capacity of the cavity is greater. The pelvis consists of paired bones - ischial, iliac and pubic. All bones are connected to each other by ligaments and fixed adhesions. The exception is the pubic symphysis (pubic articulation) - a relatively mobile connection of two pubic bones with the help of special cartilage and ligaments. Thanks to the hormone relaxin, during the bearing of a child, the pubic symphysis and ligaments of the pelvis become loose and soft. This ensures good divergence of the bones during the progress of the child through the pelvic bone ring. Normally, the pubic bones can diverge up to 0.5 cm by the time of birth.

What is a rupture of the pubic joint?

Violation of the integrity of the pubic cartilage and retaining ligaments with a divergence of the pubic bones of more than 0.5 cm and a pronounced pain syndrome is called a rupture of the pubic joint. Fortunately, in modern obstetrics, this is a relatively rare complication. More often during pregnancy, an isolated pain syndrome is observed in the area of the pubic symphysis with a divergence of bones up to 0.5 cm. This phenomenon is called symphysitis or symphysiopathy. It is associated with excessive release of relaxin and a lack of calcium in the diet of a pregnant woman.

Causes of rupture of the pubic joint during childbirth

discrepancy between the size of the pelvis of a woman and the size of the fetus, the so-called clinically narrow pelvis;
fast or rapid childbirth;
narrow pelvis or history of pelvic trauma;
numerous (more than 3) genera;
improper provision of obstetric aids (imposition of forceps, vacuum extractor, Christeller's reception and others);
Outside childbirth: car and sports injuries.

Signs and symptoms of pubic symphysis rupture

Complaints with ruptures of the pubic joint are quite specific:

pain in the pubic area, aggravated by attempts to stand up or roll over on one side;
“Stuck heel symptom” is a diagnostic technique when the doctor asks to raise the leg in the supine position. A woman with a rupture of the pubic joint will not be able to complete this task;
"frog pose" - it is easier for a woman to lie on her back with her hips extended;
“duck gait” - a woman walks, waddling from side to side.

With discrepancies of the pubic bones up to 2 cm, the patient is able to move independently. The muscular frame reduces the bones of the pelvis, masking the problem. For diagnosis, an x-ray of the pelvis is used, where the gap between the branches of the pubic bones is clearly visible in the picture. To clarify the diagnosis of symphysiopathy in pregnant women, ultrasound that is safe for the fetus can be used.

Treatment of rupture of the pubic joint

The treatment of postpartum pelvic injuries is a very painful and lengthy process, which used to take up to one and a half months in severe cases. Fortunately, orthopedics have stepped forward, and some innovations can reduce this process to 2 weeks. So, the methods of treatment of ruptures of the pubic symphysis:

Full bed rest on rigid boards, tight bandaging of the pelvis using weights from 2 to 10 kg;
Finding a woman in a special hammock that reduces the bones of the pelvis, allowing the cartilage and ligaments to recover;
The modern orthopedic industry produces special designs for the treatment of pelvic injuries. Wearing a rigid pelvic girdle or symphyseal bandage allows a woman to get up and walk in 2-3 weeks;
Physiotherapeutic procedures: electrophoresis with novocaine relieves pain; ultrasound and magnetotherapy on the pubic area improve microcirculation and promote a speedy recovery;
Physiotherapy exercises and massage in the early stages after the disappearance of the pain syndrome help to return the muscles to tone;
Taking calcium and vitamin D3 supplements, dosed ultraviolet irradiation contributes to the speedy recovery of the symphysis.

Planning pregnancy after rupture of the pubic joint

With such a severe complication, after long-term treatment and rehabilitation, a natural question arises: “What about the next birth?”

There is no single answer to this question, and different guidelines provide different data. Some experts argue that in the absence of a symphysitis clinic, combined with the normal size of the fetus and the woman's desire, natural childbirth is possible. It is first necessary to undergo an ultrasound scan of the symphysis, to establish the degree of its discrepancy, as well as to perform fetometry of the fetus with the determination of the estimated weight. However, most gynecologists are inclined to believe that the risk of re-rupture is too great to go for a natural birth. Doctors agree on one thing: the next pregnancy should be planned no earlier than three years after the end of rehabilitation.

Alexandra Pechkovskaya, obstetrician-gynecologist, specially for the site

The divergence of the pubic articulation (pubic symphysis) is a separation of bone tissue that requires immediate treatment. This is due to softening of the pelvic bones due to intense blood supply and swelling of the cartilage. In most women, the discrepancy does not exceed 0.5 cm. When the pubic joint is torn, the bones can diverge by 7-8 cm, this usually occurs during operative delivery or strong labor activity. In total, there are 3 degrees of divergence of the pubic joint:

The first - the pubic branches diverge by 5-9 mm, women often do not notice any changes in well-being. Pathology can be diagnosed only by palpation or by the results of an X-ray examination.
The second - the pubic branches diverge by 1-2 cm, women complain of pain in the lower abdomen during movement.
The third - the pubic branches diverge by 2 cm or more, which indicates a rupture of the bone tissue. Patients feel severe pain that interferes with a normal lifestyle. During palpation, there is severe swelling in this area, several fingers or a hand can be placed between the bones. Treatment of a divergence of the womb of the third degree takes about two months.

The divergence of the pubic joint can be spontaneous and violent. In the first case, such a pathology occurs due to spontaneous or too violent labor activity, improper removal of the fetal head by a midwife. Violent divergence occurs due to surgical interventions or during separation of the placenta. A rupture of the womb is a more serious discrepancy that requires a long recovery period.

Causes

During the gestation of the fetus, the pelvic bones begin to soften in a woman. Also, as the fetus develops, the head of the fetus begins to put pressure on the bone ring, which is why the bones begin to diverge. Women with a narrow pelvis and women with large fetuses are at increased risk. To provoke a discrepancy or rupture of the pubic joint can:

Fruit weighing more than 4000 grams.
Sequelae of serious injury.
Rapid or prolonged labor.
History of pelvic fracture.
Numerous genera.
Improper obstetric care.
Bone inflammation.

Symptoms

Symptoms of pubic symphysis depend on the degree and duration of the lesion. In most cases, women complain about:

soreness in the pubic area, which intensifies even during minimal exertion.
Change in gait - the patient seems to roll over from foot to foot.
Inability to raise the leg perpendicularly when lying on the back.
Pain subsides when she lies with her hips extended.

Usually, when the womb diverges up to 20 mm, a woman manages to move independently.

The problem may not manifest itself for a long time, as the muscular frame reduces the discrepancy. Also, the fact that pain cannot be stopped with analgesics can also indicate pathology.

Diagnostics

Diagnosis of divergence or rupture of the womb does not cause difficulties. The specialist needs to collect a detailed history: find out when the pains appeared, what they are, in what position the discomfort increases. After that, an external examination is carried out: with a discrepancy between the edges of the pubic joint, several fingers, and sometimes a palm, can be placed. Vaginal examination confirms bone separation. To clarify the diagnosis, an x-ray of the pelvis is performed. It helps to accurately determine the size of the discrepancy and its degree, the condition of the articular surfaces and their shape. The x-ray also shows if the sacroiliac joint is affected.

Impact on childbirth

The divergence of the womb is not an absolute indication for caesarean section. This method of delivery is carried out with a large size of the fetus with a voluminous head, a narrow pelvis in a pregnant woman, or when the bones diverge by 1 centimeter or more. If the discrepancy occurs during childbirth, the woman feels pain intensifying during the movement of the legs. With a serious discrepancy, you can hear the sound of torn ligaments, after which the fetus begins to rapidly descend. A few weeks after childbirth, the pain becomes more intense. Also, after childbirth, this phenomenon is rare, however, with severe swelling of the small pelvis, the pubic bones can still diverge by 5-6 millimeters.

Treatment

Treatment of postpartum discrepancy or rupture of the womb is a long and painful process that takes from 2 weeks to 6 months. For the convergence of bone tissue, a woman must constantly observe hard bed rest on special shields, and tight bandaging is also necessary. In case of a serious injury, the patient remains in the hospital and is placed in a medical hammock. Being in this position, the bones and cartilage begin to grow together rapidly.

After the integrity of the bone tissue is restored a little, the attending specialists prescribe a special physical education, and also send the patients for a massage. This helps reduce pain and speed up the healing process. According to the doctor's prescription, you can be prescribed vitamin complexes and medications that contribute to the rapid recovery of the body.

Rehabilitation and prevention

In order to speed up the healing process and prevent the pubic joint from divergence in the future, a woman must ensure the proper development of her body: eat well, perform special physical exercises to strengthen the muscular skeleton. With the help of special gymnastics, it is possible to strengthen the pelvic bones, which will prevent the divergence of the bones in the future. It is also necessary to take a responsible approach to the management of childbirth, especially after operative delivery.

The content of the article:

The birth of a baby is one of the most beautiful moments in a woman's life. But not always being in the birthing room is pleasant. A woman experiences great pain, which she endures to the last, but after childbirth, pain and discomfort may remain due to changes that have appeared during childbirth. Many women say they have pelvic problems after giving birth. To understand the mechanism of childbirth, you need to know a little about the anatomy of the pelvis.

In order for a child to be born, it must pass through the birth canal, which is formed by the bone pelvis and soft tissues. From the sides of the baby is surrounded by the ilium, ischium and pubic bones. These bones are connected behind by the sacrum with its ligaments, and in front by the pubic symphysis.

The pubic symphysis itself is the fusion of the right and left pubic bones with the help of a cartilaginous disc. Therefore, in its center there is a small joint space in which there is joint fluid. The entire symphysis is surrounded by ligaments that hold it tightly. This articulation is similar to a joint, but it has a very small angle of motion. Normally, the joint space reaches only one centimeter, but the pelvic bones diverge before childbirth, and this distance becomes large. In front of the pubic joint is the pubis, which is represented by adipose tissue and a ligament that raises the clitoris. Nerves and blood vessels pass behind the pubic bones, the bladder and its excretory canals are located.
So, do the pelvic bones really move apart after childbirth? Yes. But to be more precise, the pubic joint is stretched.

What causes the divergence of the pelvic bones

There is a physiological explanation for this phenomenon. During pregnancy, a woman's pelvis undergoes changes in order to make childbirth as easy as possible. Any woman can argue that there is nothing easy in the process of giving birth to a baby. But if there were no changes in the bones of the pelvis during pregnancy, childbirth would be like a horror movie. Both the baby and the mother must remain healthy and alive, so there are normal changes in the articulation.

During pregnancy, the ovaries and placenta produce a substance called relaxin. As the name suggests, it has a relaxing effect. Relaxin, mixing with female sex hormones, causes swelling of the ligaments and cartilage of the semi-joint, they become loose. In addition, small gaps filled with fluid form in the joint. The friability of the ligamentous apparatus and the joint fluid give the pelvis greater mobility. Between all the bones of the pelvis there is a discrepancy.

But most of all, these changes affect the pubic symphysis, blood supply to it increases. As a result, the ligaments and soft tissues swell, which increases the articulation in size, the gap expands by millimeters. In addition, the symphysis can move up and down, as if the keys of an instrument. As a result, the gap can increase to several centimeters. The junction of the sacrum diverges minimally, but after delivery, the pelvic bones will fall into place. Joint gaps will again become dense, ligaments and cartilage will acquire their elasticity. But other factors can also be the cause of the divergence of the pelvic bones.

Excessive divergence of the pubic symphysis leads to changes in the osteoarticular system of the body. This takes on the appearance of pathology, the pelvis after childbirth brings discomfort and pain. This phenomenon is called symphysiopathy, and toxicosis becomes the main role in its appearance.

And also the following factors affect the skeletal system:

Violations in phosphorus-calcium metabolism. The main structural component of teeth and bones is calcium. The hormone, calcitonin, and vitamin D regulate the metabolism of calcium and phosphorus in the body. Calcitonin is produced by the parathyroid glands, and the synthesis of vitamin D occurs with the participation of the thyroid gland. Therefore, during pregnancy, the nutrition of a woman is very important, the diet should have enough phosphorus and calcium. With a shortage of these elements, they will come out of their depots - bones and teeth. As a result, the bones will be subject to pathological influence.

With vitamin D deficiency, there is a violation in the metabolic processes of the intestine, where calcium and phosphorus are absorbed. Micronutrient reserves are drawn from the bones, which leads to demineralization. In the absence of calcium in the blood, other problems may appear, such as: kidney failure, gastrointestinal pathology.

Dysfunction of the pubic joint

One of the causes of the pathological divergence of the symphysis is DLS. There are three stages in the pathogenesis of this phenomenon:
1. The period before childbirth. Leading links: heredity, low back pain in early pregnancy, hypo- or hyperactivity, use of oral contraceptives, traumatic injuries of the pelvis or back. It is possible to develop DLS in multiparous women.
2. The birth itself. Obstetric surgery, large or overdue fetus.
3. The period after childbirth. Lactation.

Symptoms

Now it became clear that symphysiopathy leads to the divergence of the pelvic bones. The first signs may appear during pregnancy. Since the calcium depot is depleted, teeth begin to crumble, night cramps, fatigue, paresthesia appear, brittle nails develop. With a slight divergence of the symphysis, pain appears, they are volatile in nature and are very similar to osteochondrosis or sciatica. Pain in the later stages appear with prolonged standing, walking. They are more pronounced, which makes you change your posture. Therefore, a woman should not wonder: how to expand the pelvis before childbirth, nature itself will do everything.

Symphysiopathy occurs most often in a latent form, the uterus increases in size with pregnancy. But the symphysis is firmly held by the abdominal muscles, immediately after the muscles become more flabby, and the symphysis can diverge up to several centimeters. What to do if the pelvic bones parted during childbirth? Most likely, they parted from the weakening of the muscles of the abdominal wall. Depending on the distance between the pubic bones, there are:
1 degree of discrepancy - from 5 to 10 mm;
2 degree - from 10 to 20 mm;
Grade 3 - from 20 mm or more.

Diagnostics

It is not difficult to diagnose 2 and 3 degrees of discrepancy. Pain sensations acquire a permanent character, become clearer with a change in posture, movement of the legs, with the act of defecation. To relieve pain, the woman sits on the bed, her posture is very similar to a frog - knees bent, hips looking to the sides, arms turned outward. How to narrow the pelvis after childbirth, if the discrepancy is more than 2 centimeters, and the gait is similar to a duck, the doctor will tell. Indeed, in this case, during palpation of the pubic joint, there will be pain that radiates to the vagina and forward. When you try to press your index finger, the pillow is quietly placed there. But in order to accurately establish the diagnosis, it is necessary to conduct an ultrasound and x-ray diagnostics. During pregnancy, it is better to use ultrasound, it will detect both discrepancy and pathology in the bones. An x-ray is harmful to the fetus, and it also only shows the presence of a discrepancy.

In addition, you need to check the content of magnesium and potassium ions in the venous blood and in the urine. In the pathology of the articulation, a decrease in values by almost 2 times is observed, at a time when the numbers in the urine can exceed the reference values. The use of laboratory methods helps to suspect pelvic dehiscence even when a woman does not feel pain or discomfort in the pelvic area.

Treatment

Do the pelvic bones converge after childbirth? Yes. With a divergence of the pubic symphysis, surgical intervention is not required. With a slight distance between the bones immediately after childbirth, the doctor recommends reducing physical activity. During pregnancy and after, it is important to wear a bandage that will hold the symphysis together with the abdominal muscles in strength. In addition, it is better to purchase an orthopedic mattress so that the spinal column is unloaded and does not bring unnecessary back pain. Of the measures aimed at strengthening the muscles and ligamentous apparatus, it is worth choosing preparations of potassium, magnesium, for bones - calcium. It will not be superfluous to take B vitamins, sunbathing, which will help to absorb microelements.

If the distance between the pubic bones exceeded 1 cm, then you should think about how to reduce the pelvis after childbirth. Firstly, you need to bring the bones closer together, and secondly, keep them in this position. Bed rest meets the tasks set, how long does the pelvic bones converge after childbirth in different women? After all, not every mother can lie in bed from 2 to 6 weeks, you can not only walk, but also get up. In addition, the pelvis should be tightly bandaged, after which a bandage is put on.

Exercises for the small pelvis can be avoided if, immediately after childbirth, ice is applied to the symphysis area and a course of physiotherapeutic procedures is taken. Reinforcing treatment will be the intake of vitamins, calcium supplements and, if necessary, painkillers. It happens that along with the discrepancy, symphysitis is diagnosed, then you need to add antibacterial drugs to the treatment. The very nutrition of a woman should be rich in calcium, magnesium and potassium.

After the above procedures, an X-ray control is needed, on the basis of which a bandage is selected. But when wearing it, it will be possible to get up and feed the baby. But strong loads at first will still be banned. It is recommended to wear a corset for up to six months.

Consequences

Symphysiopathy, as well as the divergence of the pelvic bones, are conditions that proceed extremely favorably. This pathology is not an indication for caesarean section. During childbirth, different techniques are used depending on the degree of divergence of the bones. Only with a strong discrepancy and a danger to the pelvic bones is it recommended to perform a caesarean section.

The most unpleasant thing that symphysiopathy brings to a woman is bed rest and restriction of motor activity. Very rarely, exercises for convergence of the pelvic bones after childbirth can aggravate the situation and lead to a rupture of the symphysis if the distance between the edges of the bones exceeds grade 2. But this happens more often in the birth itself, if the pelvis is initially narrow, and the labor activity is strong.

When ruptured, the bladder can be injured, hematomas can form in the pelvic cavity. They may be accompanied by an inflammatory process. With severe damage to the symphysis during the birth of a baby, urgent surgical intervention is required. After which it will be possible to start physical activity after 4 or more months.

Prevention of the divergence of the pelvic bones will be the right lifestyle, nutrition enriched with trace elements, physical activity. Every woman should know and understand that the health of the unborn baby depends only on her.

Symphysitis can be called one of the specific diseases, which is more inherent in pregnancy and the postpartum period. For inflammation of the pubic joint, specific symptoms and causes are characteristic. The method of delivery will depend on the exact stage of the pathology. Let's figure out how the disease affects the child and the birth process. We learn about the main directions in the treatment and methods of prevention.

paired pelvic bones;
sacrum;
coccyx.

Paired pelvic bones are divided into ischial, iliac and pubic. All these bones are interconnected by ligaments and fixed adhesions in a ring in which the internal organs are located. Until the age of 16–18, the pelvic skeleton is held together by cartilage, which hardens with age.
The female pelvis, unlike the male, is wider and flattened, which is of paramount importance for the birth process.

What is symphysis

Unlike other paired bones, the pubic bones are connected in front with the help of a movable pubic symphysis, or pubic articulation.

Symphysis - transitional connection between the bones of the skeleton. Usually it is a fibrous or cartilaginous joint, inside of which there is a narrow slit-like cavity. Outside, the symphysis is not covered with a capsule, and the inner surface of the fissure is not covered with a synovial membrane. The symphysis can be strengthened by interosseous ligaments. The connection allows small displacements of the articulating bones.
Wikipedia

https://en.wikipedia.org/wiki/Symphys

The symphysis connects not only the pubic bones, but also the bones of the skull, chin, intervertebral discs, and sternum.
In all pregnant women, the pubic symphysis softens and slightly stretches.

What is symphysis

Symphysitis is an inflammatory disease of the musculoskeletal system, which is characterized by excessive softening and stretching of the symphysis.

For the successful resolution of childbirth, the pubic symphysis must acquire mobility, which happens at the stage of pregnancy under the influence of the hormone relaxin. In some cases, such softening turns into an inflammatory process that occurs not only during gestation, but also after childbirth. Symphysitis is diagnosed when the stretching of the pubic joint exceeds the norm.

How do the symptoms of pubic symphysis divergence manifest?

One of the main signs of symphysitis is pain in the pubic area, especially when pressed, moving. The woman has difficulty walking, turning over during sleep, climbing stairs. The pain can be of different intensity and give to the lower back, coccyx, anus, perineum. Additional symptoms are:

swelling in the pubic area;
crunch;
lameness;
duck, mincing gait;
stiffness of movements;
heaviness in the lower abdomen.

At the beginning of the disease, pain is characteristic of various movements, changes in body position. Especially noticeable are unpleasant manifestations at night. As the pathology progresses, pain increases. They can occur even in an immobilized state. The disease can remain unchanged throughout pregnancy.

Diagnosis of symphysitis

When the first pains appear in the pubic area, a woman should not make a diagnosis on her own. Only a qualified medical worker can accurately determine symphysitis and its stage. The expectant mother needs to inform the gynecologist at the next turnout about the nature of pain and accompanying symptoms. You may need follow-up over the course of several weeks. If the doctor considers it necessary, he will send for a consultation with a traumatologist or surgeon. Since X-rays are contraindicated in pregnant women, ultrasound will help in making a diagnosis.

The ultrasound procedure will help to accurately determine the presence of symphysitis and the stage of its development

Causes of symphysitis

Under the influence of hormones, the female body undergoes significant changes during pregnancy. Unfortunately, some conditions cause discomfort. Pain in the pubic area is familiar to almost all pregnant women, but not in all cases pathology is diagnosed. In medical science, there is no consensus on the causes of symphysitis. There are several factors that contribute to excessive stretching of the pubic joint:

lack of calcium and other vitamins;
increased production of the hormone relaxin;
excessive weight gain of the child and mother;
incorrect or low position of the child;
polyhydramnios;
narrow pelvis of a woman;
heredity;
diseases of the musculoskeletal system;
infections of the pelvic organs;
a large number of births;
existing injuries of the pelvic bones.

If a woman is deficient in calcium, as well as other valuable substances (vitamin D, magnesium, phosphorus) necessary for successful gestation, then gradually the body will signal a lack of aching or sharp pain in the pubis. Sometimes the hormonal background fails, and the ovaries produce more relaxin than necessary. Accordingly, the softening of the symphysis occurs more intensely, which also causes pain during movement.
So that a pregnant woman does not have problems with teeth and bones, you need to eat foods rich in calcium daily.

In each case, finding the main cause of symphysitis is quite difficult. Based on the overall clinical picture, the doctor determines the most likely factors that led to the pathology.

Degrees of symphysiopathy

Normally, the stretching of the pubic symphysis should not exceed 4–5 mm. Symphysitis is characterized by three stages of development, depending on the degree of divergence of the bones:

The interval between the bones is 5–9 mm.
From 10 to 19 mm.
From 20 mm.

The effect of symphysitis on pregnancy and childbirth when a caesarean section is indicated

Any painful sensations have an adverse effect on the course of pregnancy. At least because they prevent a woman from enjoying the process and being in a joyful state. Pain can become a source of stress, dangerous both for the expectant mother herself and for the life and health of the child. The divergence of the pubic joint as such does not adversely affect the development and growth of the baby in the womb, but causes inconvenience to the woman.

As a rule, no signs of symphysitis are found in the first trimester. If at this stage pain in the pubic area is disturbing, then this is most likely an infection of the genitourinary system. For diagnosis, it is necessary to conduct a study of urine and smear.

In the second trimester, the first signals of symphysitis begin. The process is different for everyone. Already from the 13th week, hormonal changes make themselves felt: the pelvic bones soften. The resulting pain is episodic and is especially acute after excessive physical exertion. From the 20th week, the natural process of bone softening increases, but symphysitis is not diagnosed in all cases.

Most often, the doctor diagnoses symphysitis in the third trimester. Observing the patient in dynamics, and, having established the exact degree of stretching of the pubic joint, the doctor decides on the method of delivery. In the first and second stages, natural childbirth is recommended. Only in the second stage, anesthesia or stimulation of labor is used. When the second degree is complicated by the narrow pelvis of the patient, a large fetus, or other provoking factors, the gynecologist may suggest surgery for the woman.

In the third stage of symphysitis, gynecologists prescribe a caesarean section, since there is a risk of rupture of the pubic symphysis. To dispel doubts when agreeing to an operation, you can consult with several gynecologists.

How does the rupture of the symphysis manifest itself, why is it dangerous

Rupture of the symphysis is a severe complication of symphysis. Fortunately, in obstetrics, such cases are very rare. The main causes of the violation are the extreme load on the pubic joint during childbirth, previous injuries and incorrect obstetric actions. The symptoms of a rupture are as follows:

piercing pain in the pubic area when changing position;
in the supine position, the woman cannot raise her leg;
the only relieving position is to lie on your back with your hips extended;
if there is the ability to move, then the gait is similar to that of a duck.

With a rupture of the pubic joint, the danger lies in the long-term rehabilitation of a woman. As a rule, treatment is aimed at strict bed rest in tight bandages, physiotherapy, massage, physiotherapy exercises, and taking calcium-containing drugs. The pain syndrome stops on the 5-7th day. The condition stabilizes in two weeks, in especially severe cases - up to three months. When the rupture of the symphysis is too large, the doctor may recommend surgical treatment. Of course, a woman in this state will not be able to fully care for a child.

The downside is that in subsequent pregnancies, the risk of re-rupture is very high. Therefore, gynecologists recommend planning the next conception no earlier than three years after undergoing rehabilitation measures. In most cases, new births will be resolved by caesarean section.
Symphysis ruptures can be affected by fast, rapid or multiple (more than 3) births

Treatment

It should be noted right away that it is impossible to completely get rid of symphysitis. Mild, mild pain will accompany the woman throughout the pregnancy. After childbirth, when the hormonal background is established, the signs of the disease will disappear. Symphysitis of the first stage also does not require special treatment. It is advisable to carry out therapeutic measures when pain interferes with full bearing. As a rule, treatment is aimed at achieving three main goals:

reduction of pain syndrome;
neutralization of factors provoking divergence of bones;
the return of the bones to their original place.

With progressive severe pain, a pregnant woman is prescribed:

vitamin complexes with calcium;
anti-inflammatory drugs;
painkillers in tablets or injections (No-shpa, Paracetamol);
the use of external agents (Menovazin, Betalgon ointment, Chondroxide gel, etc.);
regular wearing of a bandage;
physiotherapy;
adherence to a special diet;
exercise, massage.

It must be remembered that in the last month of pregnancy, gynecologists do not recommend synthetic calcium, since it can provoke excessive hardening of the bones of the woman's pelvis and the baby's skull - this will greatly complicate the birth process. The best option would be to eat foods with a high content of calcium.

I have had to endure pregnancy three times in my life. From personal experience, I can say that a new gestation was accompanied by an increase in soreness in the pubic area, and each time the discomfort manifested itself earlier and stronger. I have experienced all the symptoms described above. I want to note that the gynecologist prescribed only synthetic calcium as a treatment, and ultrasound was only scheduled. At that time I did not yet know about the ways to prevent symphysitis, but the maternal instinct suggested the right actions: I did special exercises, tried to eat right, swam regularly in the pool, wore a bandage. All pregnancies resolved naturally. After childbirth, the signs of the disease disappeared, as if they were not there. I think the main thing is to wind up less negative thoughts.

Therapeutic exercise for symphysitis

Therapeutic exercises are aimed at strengthening the muscles of the pelvis, lower back, and hips. If possible, it is better to train in a special medical center under the supervision of an experienced instructor. Physical activity not associated with therapeutic loads should be kept to a minimum. Effective exercises are the following:

1 exercise. In the supine position, the legs are bent at the knees and placed close to the buttocks. Slowly spread your knees to the sides until they stop, linger a little and again smoothly bring them together. Repeat 4-6 times.
In this exercise, the main thing is not to overdo it, you don’t need to spread your knees to pain

2 exercise. Starting position as in the first exercise, only put your legs perpendicular to the floor. Carefully, slowly lift the pelvis up from the floor, then gently lower it to the floor. Repeat 5-6 times.
You need to raise the pelvis up very smoothly as much as possible, and touching the floor with the coccyx, linger a little in this position, then lower it completely

3 exercise. "Cat". Slowly round and arch your back. Repeat 2-3 times.
In the starting position, the head, neck and spine should be in line

Prevention of symphysitis

Preventive measures are always preferable to the treatment of diseases during pregnancy. At least a year or two before the planned conception, you need to undergo an examination and cure all existing diseases. It is very important to lead a healthy lifestyle: a balanced diet and adequate exercise. So that symphysitis does not disturb during gestation, it is useful to follow the following recommendations:

monitor weight gain
do not walk for a long time;
if possible, avoid climbing stairs;
is not more than an hour in one position of the body;
remove asymmetrical postures (cross, throw legs, lean on one leg);
during sleep, keep your legs above the body, put pillows under your lower back;
when changing the position of the body, first turn the upper body, then the pelvis;
sleep on an orthopedic mattress;
wear a bandage regularly;
do therapeutic exercises;
you can not sit and lie on a hard surface;
eliminate high heels;
go swimming;
avoid stressful situations;
the gait should be smooth, without wide steps.

If a woman has a history of household or sports injuries in the form of fractures of the pelvic bones, then preventive measures should be taken with particular seriousness. When previous pregnancies were complicated by symphysitis of any degree, with repeated gestation, it is important to register as early as possible, take all the tests in a timely manner, undergo the necessary examinations, be sure to inform the gynecologist about the previous symptoms and strictly follow the doctor's recommendations for disease prevention.

The most characteristic are complaints of pain in the area of the corresponding joint of the pelvis, which appear most often on the 2-3rd day after childbirth. The pain is sharply aggravated by movements of the legs. The puerperal is as if bedridden, the hips are somewhat turned outward and at the same time deployed with slightly bent knees (“frog” position) - a symptom of N. M. Volkovich. Breeding the legs sharply exacerbates the pain. The gait of the puerperal, when she is allowed to stand up, waddles, the so-called duck.

The most common damage to the pubic joint. In some cases, the woman in labor herself feels a rupture of the pubic joint, a crackling sound is heard during the rupture, and the presenting part, which was previously motionless, quickly falls. But these signs are inconsistent and rare.

The clinical picture depends on the degree of divergence of the pubic bones. There are three degrees of their divergence, which is established radiographically (J. Bumm, K. S. Zalevsky, M. A. Dubinina). The first degree - the divergence of the pubic branches - by 5-9 mm, the second degree - by 10-20 mm, the third degree - by more than 20 mm.

With the divergence of the pubic bones of the first degree puerperas usually do not show complaints. Only a thorough survey and palpation of the pubic joint can suggest the possibility of a discrepancy, and an X-ray examination finally establishes the diagnosis (Fig. 131). In most cases, discrepancies of the pubic articulation of the first degree are visible, and since they are usually diagnosed and do not require treatment, their practical significance is small.

Rice. 131. Stretching of the symphysis (X-ray).

With the divergence of the pubic bones of the second degree puerperas complain of pain in the symphysis and difficulty walking.

The most pronounced signs with the third degree of divergence of the pubic bones. Postpartum women complain of severe pain in the symphysis area, cannot make active movements in the lower extremities, turn on their side. They are forced to observe bed rest and lie in a position with the hips turned outward: palpation of the womb is determined by swelling and soreness in this area, mobility or wide separation of the pubic branches from one another. X-ray examination finally confirms the diagnosis (Fig. 132).

Rice. 132. Rupture of the symphysis (X-ray).

Pain continues for several weeks, walking is impossible for 3-10 weeks, depending on the severity of the injury. With inflammation of the symphysis, sacroiliac and sacrococcygeal joints, the first signs appear on the 2-3rd day after childbirth and are expressed in subfebrile temperature, pain, aggravated by movement, swelling, redness and soreness in the area of the corresponding joint. On radiography of the pubic and sacroiliac joints, no changes were noted.

Treatment for stretching and divergence of the joints of the pelvis

When treatment consists in bed rest, prophylactic antibiotics, transfusions of small doses of blood, vitamins and calcium chloride. Tight circular bandaging of the pelvis is used, although some obstetricians are skeptical about this event. When the symphysis diverges, it is necessary to consult a traumatologist to resolve the issue of using a “hammock” and special styling for better repositioning of the diverged bones.

Usually, the divergence of the pubic articulation is eliminated within 3-10 weeks. With severe damage to the sacroiliac joint, recovery can take a protracted form. Some women in childbirth, especially when getting up early, may have a persistent gait disorder (duck gait).

In the presence of a hematoma and its infection, it is necessary to use antibiotics, sulfonamides, and in case of suppuration - an autopsy.

Prevention of damage to the joints of the pelvis

Prevention of damage to the joints of the pelvis should consist in activities that ensure the proper development of the female body (physical education, rational nutrition, etc.). The use of medical gymnastics during pregnancy helps to strengthen the articulation of the pelvis.

Careful management of childbirth is necessary, especially with operative delivery. The latter should be carried out in compliance with all conditions and technically correct, without the use of gross, traumatic manipulations.

Emergency care in obstetrics and gynecology, L.S. Persianinov, N.N. Rasstrigin, 1983