Pubic Symphysis Rupture and Separation During Pregnancy
Pubic Symphysis Rupture and Separation During Pregnancy
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DOI：
10.1097/ogx.0000000000000247
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发表时间：
2015-11-01
影响因子：
6.2
通讯作者：
Ahmadi, Shahryar
中科院分区：
文献类型：
--
作者：
Shnaekel, Kelsey L.;Magann, Everett F.;Ahmadi, Shahryar
目的本研究的目的是确定危险因素，临床和放射学标准的诊断，并管理这种不寻常的并发症的pregnancy.Methods PubMed和Web of Science的搜索进行了没有限制的年searched.Results的数量确定的36篇出版物，与19篇文章的基础上，这一审查。已经确定了多种风险因素，包括多产、巨大儿、头盆不称、产钳分娩、急产、胎位不正、既往骨盆创伤和使用McRoberts手法。诊断通常是临床，影像学证实，并考虑病理耻骨间隙大于10毫米时，磁共振成像似乎上级骨盆X线和计算机断层扫描在可视化的骨分离。保守治疗仍然是治疗的首选，但妇女谁不响应保守治疗或妇女与大分离可能需要手术稳定与外部或内部fixed.Conclusions扩大耻骨联合大于10 mm是病理。诊断是临床和证实的影像学研究，磁共振成像是上级技术。保守治疗是治疗的第一线。学习目标完成这篇教育性文章后，读者将能够评价已发表的关于围产期耻骨联合破裂的文献和相关结果;认识阴道分娩后耻骨联合破裂的临床表现;区分正常和病理性分离的影像学表现;确定最有益的治疗策略;并审查耻骨联合破裂后再次妊娠的管理建议。
Objective The aim of this study was to determine the risk factors, clinical and radiologic criteria for diagnosis, and management of this unusual complication of pregnancy.Methods A PubMed and Web of Science search was undertaken with no limitations on the number of years searched.Results There were 36 publications identified, with 19 articles being the basis of this review. Multiple risk factors have been identified including multiparity, macrosomia, cephalopelvic disproportion, forceps deliveries, precipitous labor, malpresentation, prior pelvic trauma, and use of the McRoberts maneuver. The diagnosis is usually made clinically, confirmed by imaging, and considered pathological when the intrapubic gap is greater than 10 mm. Magnetic resonance imaging appears to be superior to pelvic x-ray and computed tomography scan in visualization of the bone separation. Conservative treatment remains the first choice for therapy, but women who do not respond to conservative therapy or women with large separations may need surgical stabilization with external or internal fixation.Conclusions Widening of the pubic symphysis greater than 10 mm is pathologic. The diagnosis is clinical and confirmed by imaging studies, with magnetic resonance imaging being the superior technique. Conservative treatment is the first line of therapy. Failure of conservative therapy is treated by surgical stabilization.Target Audience Obstetricians and gynecologists, family physicians.Learning Objectives After completion of this educational article, the reader will be able to evaluate the published literature regarding peripartum pubic symphysis rupture and associated outcomes; recognize clinical presentation of pubic symphysis rupture following vaginal delivery; differentiate between normal and pathological separation on imaging; determine the most beneficial treatment strategy; and review recommendations regarding management of subsequent pregnancies after pubic symphysis rupture.