Publication:

Comparison between conservative and surgical management in postpartum pubic symphysis diastasis: a randomized controlled trial

Background Pubic symphysis diastasis is a postpartum complication with an incidence of 1:385 to 1:500 births. Typically conservative treatment is performed, operative treatment is also successful alternative method. This study was conducted to assess whether surgery (ORIF) provide early pain relief and improve mobility and quality of life than conservative management does in same patients.

Methods This study is a randomized controlled trial conducted at MKCG Medical College, Berhampur from December 2014 to April 2017. Total eligible 16 postpartum pubic diastasis patients coming to MKCG hospital were randomly assigned to two groups in 1:1 ratio. Group A received surgical and group B conservative management. All were followed up at 3 weeks, 6 weeks, 3 months and upto 6 months in which EQ-5D-3L score and Visual analogue scale were measured for assessing pain and general health outcome in participants. All data were analyzed with SPSS.

Results The mean EQ-5D descriptive index was almost similar in both groups at the time of admission, but declined more rapidly in group A as compared to that in group B. 75% of group A has this index 5 (lowest score) at 6 months whereas none of the group B patients attained it. lower EQ-5D index indicates patients had good mobility and early ambulation, less discomfort, able to do usual activity. There was a significant difference in mean EQ-5D descriptive index and pain VAS score between two groups.

Conclusions This study showed surgical management is more effective than conservative management in postpartum pubic symphysis patients by rapidly improving general health, ameliorating pain and bringing ambulation.