Symphysiolysis with avultion of bladder and urethra After Spontaneous

Vaginal Delivery: Case Report

Indra wijaya putra,Azharuddin,Teuku Nanta Aulia,Jufriadi Ismy4, cut meurah yeni5
1.
2.
3.
4.
5.

General surgery resident, Surgery Department Medical Faculty of Syiah Kuala University, Zainoel Abidin General Hospital,
Banda Aceh
Head of Orthopaedic surgery division, Surgery Department Medical Faculty of Syiah Kuala University, Zainoel Abidin General
Hospital, Banda Aceh
Orthopaedic surgery division, Surgery Department Medical Faculty of Syiah Kuala University, Zainoel Abidin General
Hospital, Banda Aceh
Urologic surgery division, Surgery Department Medical Faculty of Syiah Kuala University, Zainoel Abidin General Hospital,
Banda Aceh
Fetomaternal division, Obstetric and gynaecologic Department Medical Faculty of Syiah Kuala University, Zainoel Abidin
General Hospital, Banda Aceh

Introduction
The diastasis of the pubic symphysis is an uncommon peripartum
complication that might become a serious medical condition to the
patient. The incidence of diastasis is from 1 in 300 to 1 in 30,000
deliveries.The incidence of Symphysiolysis with avultion of
bladder and urethra After Spontaneous Vaginal Delivery is never
been reported. In pregnancy, gap between pubic symphysis in range
3 4 mm and is known as a physiological pubic diastasis. Higher
widening more 10 mm of pubic symphysis pubis is considered to
be pathological called symphysiolysis
Case Report
A 23-year-old primigravida woman was refered to dr. Zainoel
Abidin General Hospital from Bireun district hospital after 2 days
spontaneous vaginal delivery and sudden onset of severe pelvic
pain and inability to stand or walk. On her physical examination
there was pain by pelvic compression, local tenderness and gap on
symphysis. External vaginal examination found Vaginal Laceration
with urethral and bladder neck avulsion She had no history of
instrumentation or prolonged labour and she has delivered a
newborn baby weighing
3500 gr with Head Circumferencial
36cm. On her radiological examination pelvis anteroposterior view
revealed separation of symphysis pubis (symphysiolysis) about
30mm. There were no other bone pathology.. The patient was
anaemic and got blood transfussion. The separation was reduced by
internal pelvic fixation and performed urethral and bladder neck
reconstruction and Vaginal repair.
Conclution
Rapid descent of fetal head during labour may separate symphysis
pubis at a pregnant who lacks pelvic flexibility. Symphysiolysis can
be diagnosed from Physical and radiologic examination.

Pre Operative

Clinical Appearance

Pelvic Radiologic:
Symphysiolysis
Post Operative

Conservative or operative procedure can perfomed to treat

symphysiolysis depend on distance of symphisis pubis separation
Keywords: Symphysiolysis,Avultion of uretra and bladder,
spontaneous delivery

Open Reduction Internal

Fixation of symphysis pubis

Pelvic Radiologic post Open Reconstruction of urethral

Reduction Internal Fixation
and bladder neck