Symphysis Pubis Dysfunction—A Cause of Significant Obstetric Morbidity

Abstract

Too little attention is paid, even today, to symphysis pubis dysfunction (SPD), a frequent cause of pain during and after pregnancy. The symptoms vary considerably and range from mild discomfort to debilitating distress. Typically pubic pain radiates into the upper thighs and perineum, making it difficult to walk and causing a waddling gait. Climbing stairs may be very difficult. The authors sent a questionnaire postnatally to 248 women who had described pubic pain in pregnancy or shortly after delivery; 57% of them responded. The estimated incidence of SPD in the years 1997-1998 was 1 in 36 parturients. About one in five women were in their first pregnancy. Symptoms most often began in the second or third trimester; in only 2% of respondents did it begin during labor or postnatally. In a majority of women pain was limited to the pubic symphysis; the others had pain in the lower back and/or legs. In general the women were treated by rest, analgesia, and the use of support belts. Crutches were needed by 17% of those affected, and 8% were advised to rest in bed. Pain persisted postnatally in 63% of women, and in about half of them, it remained as intense as before or worsened. About one fifth continued to have pain for 3 months, and 19% had pain for 6 months; 24% still had pain when last evaluated. Roughly three fourths of women rated their pain as 7 or higher on a 1-to-10 scale. Patients reported that staff had not taken their symptoms seriously and were not especially interested. Some staff attempted to reassure them that pain is normal during pregnancy. These findings suggest that SPD causes substantial morbidity in pregnant women and that it is far more frequent than formerly thought. A majority of physicians and midwives attending the women in this study knew nothing about the condition or were uninterested. Much remains to be learned about the best means of delivery and helpful postpartum management for women with SPD.