Abscess formation after symphysis pubis diastasis in pregnancy: A case report

Document Type : Case report


1 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.

2 Medical student, Student Research Committee, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.

3 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.


Introduction: Abscess formation afterpubis symphysial separation in normal vaginal delivery is rare, and few cases have been reported in the literature. In this study, a case of abscess formation following pubis symphysis separation in normal vaginal delivery is reported that was successfully treated after identifying the infection causative organism.
Case presentation: The patient was a 23-year-old female referring to Besat Hospital Clinic, Sanandaj, with pain, swelling, and redness of the suprapubic region following second normal delivery along with increasing fever and chills. The patient reported pain and difficulty in movement before delivery, which increased after delivery. Clinical examination of the patient showed pain, sensitivity, and swelling at the suprapubic region. In laboratory studies, inflammatory markers were elevated. The patient underwent ultrasound, which showed rectus sheath hematoma and edema. The pelvic X-ray showed a pubic symphysis separation of 20 mm. The patient underwent Spire ultrasound, which indicated an abscess. In the sample culture, Streptococcus viridans was grown. The patient was treated with antibiotics imipenem and vancomycin. Due to the lack of fever, pelvic abscess was diagnosed, so a laparotomy was performed and a drain was inserted. On day 35 of hospitalization, the patient underwent X-ray before discharge; the results of the X-ray indicated a 10-mm pubic symphysis separation.
The patient was discharged in good condition.
Conclusion: In pregnant or postpartum women with general symptoms of infection, the presence of septic symphysis should be suspected and immediate and comprehensive action should be taken to treat it..





    1. Jayaraman JK, Ganapathy P, Indira N. Post-partum diastasis of the pubic symphysis: report of a rare case. Journal of clinical and diagnostic research: JCDR 2015; 9(9):QD09.
    2. Owens K, Pearson A, Mason G. Symphysis pubis dysfunction—a cause of significant obstetric morbidity. European Journal of Obstetrics & Gynecology and Reproductive Biology 2002; 105(2):143-6.
    3. Mulchandani NB, Jauregui JJ, Abraham R, Seger E, Illical E. Post-partum management of severe pubic diastasis. Clin Exp Obstet Gynecol 2017; 44(3):464-6.
    4. Rowarth G. Osteomyelitis of the Pubic Bones and Staphylococcal Septicaemia complicating Pregnancy Unusual Changes in Presentation of the Foetus during the later weeks of Pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology 1940; 47(2):213-9.
    5. Hussein, PFT Sewell R. Antero-symphysial abscess formation after symphysial disruption in pregnancy. Journal of Obstetrics and Gynaecology 2000; 20(3):313-4.
    6. Dunk RA, Langhoff-Roos J. Osteomyelitis of the pubic symphysis after spontaneous vaginal delivery. Case Reports 2010; 2010:bcr0120102610.
    7. Lawford AM, Scott K, Lust K. A case of massive vulvar oedema due to septic pubic symphysitis complicating pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology 2010; 50(6):576-7.
    8. Froberg L, Eckardt H. Osteomyelitis of the pubic symphysis-A case report. Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology 2015; 35(8):862-3.
    9. Lovisetti G, Sala F, Battaini A, Lovisetti L, Guicciardi E. Osteomyelitis of the pubic symphysis, abscess and late disjunction after delivery. A case report. La Chirurgia degli organi di movimento 2000; 85(1):85-8.
    10. Kavanagh N, Ryan EJ, Widaa A, Sexton G, Fennell J, O'rourke S, et al. Staphylococcal osteomyelitis: disease progression, treatment challenges, and future directions. Clin Microbiol Rev 2018; 31(2).
    11. Putschar WG. The structure of the human symphysis pubis with special consideration of parturition and its sequelae. American Journal of Physical Anthropology 1976; 45(3):589-94.
    12. Bombaci H. Outcome of Internal Fixation and Corticocancellous Grafting of Symphysis Pubis Diastasis Which Developed after Malunion of Pubic Rami Fracture. Hip & pelvis 2017; 29(2):150-153.
    13. Albert H, Godskesen M, Westergaard J. Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. European Spine Journal 2000; 9(2):161-6.
    14. Herren C, Sobottke R, Dadgar A, Ringe MJ, Graf M, Keller K, et al. Peripartum pubic symphysis separation–Current strategies in diagnosis and therapy and presentation of two cases. Injury 2015; 46(6):1074-80.
    15. Norvilaite K, Kezeviciute M, Ramasauskaite D, Arlauskiene A, Bartkeviciene D, Uvarovas V. Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature. World journal of clinical cases 2020; 8(1):110-119.
    16. Magnúsdóttir R, Franklin J, Gestsson J. Septic symphysial disruption presenting as severe symphysiolysis in pregnancy. Acta obstetricia et gynecologica Scandinavica 1996; 75(7):681-2.
    17. Cosma S, Borella F, Carosso A, Ingala A, Fassio F, Robba T, et al. Osteomyelitis of the pubic symphysis caused by methicillin-resistant Staphylococcus aureus after vaginal delivery: a case report and literature review. BMC infectious diseases 2019; 19(1):952.