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Symphysis fracture at deliveryFrom: dahmd@gate.netSun Oct 13 16:24:01 1996
To the list: I wanted to present a brief, unusual case I had recently of a symphysis pubis fracture in labor: A teenage primigravid at 39 weeks gestational age presented in active labor and progressed normally and began pushing at complete/complete/ +1 station. After a few pushes, she closed her legs and *really* pushed. We heard a disturbingly loud "popping" noise, and the head progressed to the perineum quickly. She delivered spontaneously of a 7 pound health baby over an intact perineum without difficulty, and inspection of the pubis revealed a remarkably large separation of the pubic symphysis (at least 5-6 cm). A gasp from the intern of "hey, what's *this*" got my attention, and I found a large right anterior sidewall laceration with a large piece of pubic bone easily visible. Palpation into the wound revealed the bladder base, the insertion of the right ureter into the bladder, the pubic ramus, and lots of muscles, nerves, and blood vessels! The orthopaedic surgeon I called in to look things over initially thought it was a ramus fracture, but it ended up being a huge separation of the symphysis down into the sidewall. x-rays were otherwise negative. I ended up doing cystoscopy to check the urethra (which was kind of avulsed) and putting in a right ureteral stent due to lack of indigo carmine coming out of the right ureter, but it turns out is was just compression from edema (thankfully). Creative suturing, antibiotics, and a drain did the trick and she did well. Anybody seen anything similar? It sure woke me up. Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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