Successful delivery management in a patient with symphysiopathy and a burdened obstetric history: Асase report

Symphysiopathy is a result of functional or anatomical separation of the pubic symphysis. This condition most commonly occurs in the second half of pregnancy and the postpartum period; its frequency ranges from 1:300 to 1:30,000 deliveries. Although relatively rare, even minimal manifestations of symphysiopathy may significantly influence the choice of delivery method and pregnancy outcomes.We present a case of successful delivery in a woman with grade II symphysiopathy and a previous grade III perineal rupture.Patient A., born in 1991, was registered for antenatal care at 12 weeks and 3 days of gestation. Obstetric history: First delivery: 2020, birth weight –3400 g, episiotomy performed; Second delivery: 2022, birth weight –3500 g, third-degree perineal laceration; Third pregnancy –current case.At 20 weeks of gestation, a diagnosis of first-degree symphysiopathy was established based on the assessment by a traumatologist. From 26 weeks onward, the patient was advised to wear a pelvic support belt and to plan for vaginal delivery in the absence of contraindications.Symphyseal separation measurements were as follows: First trimester –up to 6 mm, Second trimester –10 mm, Third trimester –18 mm.Throughout the observation period, no signsof pelvic instability were detected.Delivery occurred at 39 weeks and 6 days of gestation. A full-term female infant was born weighing 3665 g and measuring 55 cm in length, with Apgar scores of 9 and 10 at one and five minutes, respectively. The postpartum period was uneventful. The patient was discharged on postpartum day two in satisfactory condition.The presented clinical case demonstrates that patients with grade II symphysiopathy can be successfully delivered through the natural birth canal in the absence of other contraindications. Comprehensive monitoring and adherence to clinical recommendations ensure a positive outcome for the mother and child.Keywords:symphysiopathy, pregnancy, childbirth, clinical case.