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During pregnancy, a woman's body adapts to bearing and giving birth to a child. The female pelvis is a ring consisting of the sacrum, coccyx, as well as symmetrically placed ischial, pelvic and pubic bones. The latter are located in the center of the lower abdomen and are connected to each other along the midline by the symphysis pubis (the pubic symphysis).
Nature arranges it in such a way that during pregnancy the symphysis softens and the ligaments relax a little to facilitate the passage of the child during childbirth.
The softening is facilitated by the hormone relaxin, which is produced by the ovaries of a pregnant woman and the placenta (baby place).
Symphysitis in pregnant women: causes
In some cases, the joint is stretched beyond normal and an inflammatory disease—symphysitis—occurs. Unpleasant pain appears in the pubic area while climbing stairs or walking. It usually occurs in the late second or early third trimester of pregnancy and can also occur after childbirth. It is advisable to immediately contact your doctor at the first symptoms, who will conduct an examination and order an ultrasound of the symphysis pubis. Ultrasound diagnostics is the most informative and absolutely safe method of examining a pregnant woman and her unborn child at any stage.
The exact reasons why symphysitis occurs are not yet fully understood. There are several medical opinions on this matter. Some call the lack of calcium in a woman’s body, others consider the cause to be excessive production of relaxin. Still others are inclined to have a problem due to heredity, diseases of the musculoskeletal system, lack of collagen protein - the main component of ligaments, cartilage and skin.
Both domestic and foreign scientists also consider the following to be unfavorable factors:
Predisposition to symphysitis - symphysitis during previous births,
- sedentary lifestyle before pregnancy,
- pelvic pathology,
- child weight more than 4 kg,
- post-term pregnancy,
- a large number of births.
By and large, these are hypothetical assumptions of scientists. But if a pregnant woman has at least one of these signs, she is automatically considered at risk and must take precautions.
Referral for ultrasound diagnostics
If symphysitis is suspected, the gynecologist at the antenatal clinic will necessarily refer you for an ultrasound of the symphysis pubis.
An ultrasound should be performed in the following cases:
- acute pain appeared when walking in the pubic area, lower abdomen, radiating to the perineum, leg, lower lumbar region;
- the pain intensifies while climbing stairs, turning while lying down, standing up, bending over, but during rest the pain disappears;
- swelling of the womb appeared;
- gait has changed (small steps, they are also called “duck walk”);
- When you feel the pubis, you hear a clicking sound.
These signs appear in the second half of pregnancy.
If you notice signs of symphysitis, you should consult a doctor However, there are a number of indications for which an ultrasound of the symphysis pubis of the expectant mother is performed even in the absence of pain. Such indications include:
- the presence of post-traumatic deformities of the hip joints;
- kyphoscoliosis;
- narrow pelvis;
- large fruit;
- incorrect presentation of the fetus;
- torn pubic ligaments, pelvic pain or gait disturbance during a previous pregnancy.
What will an ultrasound of the symphysis pubis show?
Ultrasound diagnostics is a non-invasive research method that allows us to identify the following changes: softening, stretching, rupture, swelling, expansion of the pubic bones, inflammatory process. Doctor with help ultrasound machine assesses the condition of the pubic bones, ligaments, and soft tissues over the joint.
The excess fluid contained in the tissues is also determined. Using a special sensor, it is determined how much the symphysis pubis has been stretched. The norm is 5-6 mm. It is considered a pathology if these numbers are higher:
- 7-9 mm – 1st degree;
- 10-20 mm – 2nd degree;
- over 20 mm – 3rd degree.
The question of possible complications during childbirth is raised if an ultrasound reveals a stretch of 10 mm or more. If the expansion is no more than 10 mm, the child is not large, and the woman’s pelvis is of normal size, labor will proceed naturally.
Methods of delivery for symphysitis should be discussed with your doctor in advance. In any case, recommendations for delivery by method caesarean section The antenatal clinic doctor gives advice based on the characteristics of the pregnancy, the mother’s well-being, as well as taking into account the number and severity of previous births, the size of the child and other factors. After admission to the maternity hospital, the obstetrician must be informed about the diagnosis. Natural childbirth can cause rupture of the womb, which will lead to prolonged bed rest, rehabilitation measures, and mandatory observation by a number of specialists (traumatologist, surgeon, neurologist, etc.). And all this at a time when a newborn baby especially needs the presence and care of its mother.
How is ultrasound diagnostics performed?
Carrying out an ultrasound of the symphysis pubis does not require any preliminary special preparation from the pregnant woman. As already noted, it is absolutely safe and will not cause any harm to either the mother or her unborn baby. The procedure is painless and does not cause any inconvenience during it.
The examination is carried out on a special couch in a lying position. The doctor applies a water-based gel to the area being examined so that there is no air layer between the body and the sensor. The ultrasound wave contacts the area of the body being examined and is reflected from the tissues without causing any harm to them. An image of the area being diagnosed appears on the device screen. The study takes no more than 15 minutes, while direct contact with the sensor lasts only 5-7 minutes.
The harmlessness of ultrasonic waves is confirmed by the fact that diagnostic doctors conduct consultations in the usual manner, without any additional protection. But in just one shift they examine more than a dozen people. If necessary, ultrasound of the symphysis pubis is performed several times during pregnancy. You can also safely perform other diagnostic measures on the same day. No recommendations are required to be followed either before or after the examination. Immediately after the procedure, you can go about your normal activities.
If symphysitis was diagnosed on ultrasound
If during ultrasound diagnostics a significant discrepancy of the pubic bones, sprained ligaments or inflammation of the symphysis pubis is revealed, a certain regime must be followed in the future.
In the future, until the birth, it is necessary to limit physical activity, wear a special pelvic bandage, and perform gymnastics, which will be taught by exercise therapy instructors for pregnant women.
Therapeutic exercises during pregnancy will help correct problems In more complex situations, periodic treatment in a hospital, in the pathology department for pregnant women, is indicated. In between courses of treatment, it is necessary to follow all the recommendations of the treating doctor, and also limit walking, especially on stairs, monitor weight gain, eat foods rich in calcium, try to keep your legs symmetrical and sit for no more than an hour.
How to avoid the occurrence of symphysiopathy?
Damage to the symphysis pubis will in no way affect the health of the newborn, but will cause a lot of problems for the mother.
Healthy eating for the prevention of symphysitis For prevention, it is necessary to monitor your health even before conception. It has not yet been fully clarified how to avoid the occurrence of this disease, but general medical recommendations are as follows:
- eating foods rich in calcium;
- taking lacto- and bifidobacteria;
- taking vitamin complexes;
- playing sports (especially swimming, special gymnastics);
- regular walks in the fresh air;
- moderate physical activity;
- You should watch your posture and avoid sitting in one position for a long time (for example, at the computer).
Particularly important preventive measures for a woman who encountered an insidious pathology during a previous pregnancy.
An ultrasound of the symphysis pubis is done during pregnancy to determine possible start inflammatory process.
During this period, the female body is rebuilt in such a way as to provide conditions for the development of the fetus and unhindered birth.
To prevent the possible occurrence and development of pathologies, the condition of the symphysis pubis must be monitored.
A woman’s body, in its functions and structure, is adapted for bearing and giving birth to a child. During periods not associated with reproductive processes, the pelvic bones are securely fixed.
During pregnancy, certain organs begin to produce various hormones and substances. They are required to prepare the necessary conditions for the fetus to be born.
A hormone called relaxin helps soften bones, which makes them more mobile.
For the pubic symphysis this point is very important. Timely separation of the bones allows the baby to pass through the hip joint at birth.
Initially, the divergence of the symphysis pubis during pregnancy is inherent in nature. All changes that occur in the body in preparation for childbirth have certain dimensions and limits.
If a discrepancy occurs above normal, this is accompanied by pain. This condition can cause serious harm to the health of the woman and the pregnant fetus.
To prevent the development of negative processes, an ultrasound of the pubic junction is performed.
Based on the results of the study, a set of procedures is prescribed to stabilize the position of the bones and provide support. When pain is felt in the pubic area, you should immediately visit a supervising doctor.
During pregnancy, stretching of the symphysis pubis occurs that exceeds the permissible limits. As a result of the disorder, an inflammatory process flares up and develops.
This pathology is called symphysitis. The first sign of the disease is pain in the pubic area when walking. Most often, symphysitis occurs in the third trimester of pregnancy.
Sometimes the disease manifests itself even after childbirth. When the first symptoms appear, you need to see a doctor and undergo an ultrasound.
To date, the following causes of this pathology are known:
- heavy weight of the child;
- kyphoscoliosis;
- incorrect presentation of the fetus;
- small pelvis sizes.
The disease can be promoted by physical inactivity – lack of movement. Long-term practice shows that ultrasound of the symphysis pubis must be done during pregnancy for prevention.
For the vast majority of women, pregnancy proceeds without any particular difficulties or complications. At the same time, there has been an increase in the number of babies born by caesarean section.
To reduce the number of these operations, the study is carried out for the following symptoms:
- pain in the pubic area when bending over and walking;
- swelling of the womb;
- clicking sound when feeling the pubis.
Based on the results of the ultrasound, obstetricians make decisions about how the birth will proceed. When the bones diverge by at least 10 mm, and the fetus is of medium size, then labor should proceed as usual.
What does the study show?
By performing an ultrasound of the symphysis pubis during pregnancy, obstetricians receive comprehensive and timely information about the condition of the mother and fetus.
Based on the results of the study, it becomes possible to assess the condition of the body. First of all, the pubic bones, ligaments and soft tissues in the articulation area.
During pregnancy, qualitative changes occur in the elements of the pelvis:
- softening;
- stretching;
- gap;
- swelling.
It happens that the expansion of the pubic bones is accompanied by inflammation. “Excess” water accumulates in the tissues. This affects the development of the fetus to varying degrees.
It is important to note that during ultrasound of the symphysis pubis, the amount of its stretch is determined. During a normal pregnancy, this figure is 5–6 mm.
When the size of the stretch is larger, then such cases are among the pathologies of pregnancy.
As a result of many years of experience, criteria have been formed by which the degree of pathology is determined.
Expansion from 8 to 10 mm refers to the first degree. When the expansion of the symphysis pubis is in the range of 10–20 mm, this is already the second degree.
An indicator over 20 mm is classified as the third degree and poses a serious danger to the health of the woman in labor.
It should be noted that ultrasound of the symphysis pubis is performed during pregnancy at any stage. The study does not require any preparatory procedures from the woman.
The ultrasound examination method, unlike x-rays, is completely harmless for both the pregnant woman and the developing fetus.
It is important to remember that you can use the ultrasound machine at any time when there is a need for it. The entire process from start to finish does not cause any inconvenience.
In the case when the study is done on an outpatient basis, it is recommended to have a small towel or napkin with you.
An ultrasound of the symphysis pubis is performed in an office where equipment and a special couch for patients are installed.
During pregnancy, all manipulations are done in the same sequence as for other patients. A woman at any stage of pregnancy lies on her back.
To ensure reliable contact between the sensor and the body, a special gel is used.
This water-based gel is applied to the area to be scanned.
Ultrasound waves are reflected from the organ being examined, and its image is displayed on the screen. The whole procedure takes no more than a quarter of an hour.
Results and features of the study
Based on the results of the ultrasound of the symphysis pubis, a special protocol form is filled out. All received data that is intended for the observing doctor is entered into it.
During the normal course of pregnancy, no procedures or medications are prescribed to the woman.
If pathological changes are detected, the doctor must determine measures and methods of influence that should help normalize the situation.
In any case, consultations with specialized specialists will be required.
When an ultrasound of the symphysis pubis reveals symphysitis, certain techniques have to be used.
First of all, follow a strict regime. Separation of the pubic bones or sprained ligaments during pregnancy can lead to complications during and after childbirth.
With these research results, experts recommend significantly limiting physical activity and movement. In some cases, bed rest is used.
Eat a special diet, take vitamins and medications containing calcium. Good support is provided by a special bandage that gently fixes the pelvic bones.
Experience over many years convincingly proves that symphysitis is a dangerous pathology. It often happens that inflammation of the symphysis pubis or sprain of the ligaments during pregnancy is not accompanied by pain.
And only by ultrasound results can a specialist detect pathology at a certain stage of development.
For severe disorders, women are prescribed certain treatment in a special hospital.
You should limit physical activity, primarily climbing stairs, and also be sure to monitor the dynamics of weight gain.
During pregnancy, a woman is prescribed to lead a measured pace of life without unnecessary stress and stress. Ultrasound of the symphysis pubis is recommended to be done in the second and third trimester.
The research procedure should be completed regardless of the state of the body and well-being.
In order for the pregnancy to end successfully, it is necessary to perform the following procedures in advance.
In some cases, pregnancy carries with it an exacerbation of chronic diseases and the emergence of new ones. Thus, high levels of hormones such as progesterone and relaxin in the peripheral blood have a detrimental effect on the strength of bones and the elasticity of the ligamentous apparatus. As a result, the mobility of the pubic symphysis increases in a pregnant woman and, in some cases, inflammation develops - symphysitis. To diagnose this pathology, ultrasound of the symphysis pubis is used. The method is absolutely painless and quite informative.
When is it prescribed?
In the female body, the pelvic cavity performs many important functions: it is a container for internal organs and the fetus during pregnancy, a shock absorber for shocks and falls, and also, due to its pliability, facilitates the passage of the child during the process of delivery.
The pelvis itself is a closed ring, which consists of several bones:
- two ischial;
- coccyx;
- iliac pairs;
- sacrum;
- paired pubic bone forming the articulation.
At the same time, the cartilaginous structures of the symphysis pubis soften somewhat during pregnancy to ensure sufficient mobility and divergence of the pelvic bones at the time of birth. However, there are a number of signs and complaints indicating the development of a pathological process in the area of the pubic bones.
It is worth noting that pregnancy is not the only reason for the development of symphysitis or symphysiopathy (bone separation). The disease can occur as a result of connective tissue dysplasia, trauma to this area, kidney pathology, as well as a deficiency of vitamin D and ionized calcium in the blood.
Indications for prescribing ultrasound of the symphysis pubis:
- Painful sensations of a pulling or aching nature in the pubic area, occurring at rest and during dosed physical activity such as walking, climbing stairs.
- Pain on palpation of the pubic symphysis area.
- Edema, deformed or swollen pubic joint, as well as pathological changes in the soft tissues above it.
- Impaired duck-like gait, stiffness in movements, especially when abducting the hip anteriorly and to the side.
- Possible pain during sexual intercourse, urination and defecation disorders.
- The presence of symphysitis and a large number of births in the anamnesis.
- Large fetus, post-term pregnancy.
- The presence of congenital or acquired pelvic pathology (flat pelvis, simple flat pelvis, etc.).
If the above complaints and signs appear, it is recommended to do an ultrasound of the symphysis pubis, which will show the presence and extent of the lesion.
How is diagnostics carried out?
To perform the study, the patient does not require any special preparation. It’s enough just to perform morning intimate hygiene.
The subject needs to lie on the couch in a supine position and not make sudden movements. The doctor applies a special water-based gel to the sensor (to avoid creating an air gap), and then installs the transducer in the pubic area. Ultrasonic waves are reflected from the soft tissues of a person and “produce” an echo pattern on the monitor of the device.
As a rule, the examination does not take much time and is completely painless and safe.
Results standards and deviations
During an ultrasound of the symphysis pubis, the doctor takes measurements of the divergence of the symphysis, and also assesses the condition of the ligamentous apparatus and adjacent soft tissues (tears of muscles, ligaments, hematomas, etc. are excluded).
The width of the pubic symphysis, which does not exceed 6 mm, is considered normal. At the same time, a number of studies indicate that for pregnant women later it is permissible to increase these figures to 8-9 mm.
Degrees of symphysitis according to international standards:
- The first degree is an expansion of 6-8 mm.
- Second degree - the discrepancy between the upper branches of the pubic bones is 8-10 mm.
- The third degree is characterized by the fact that the area of the pubic articulation has a discrepancy of 10 mm or more.
What to do if you find symphysitis
Due to the fact that symphysitis mainly occurs in pregnant women, according to the results of ultrasound of the symphysis pubis, objective examination data (in particular, the size of the pelvis) and indicators of ultrasound examination of the fetus (the amount of amniotic fluid, multiple pregnancy or not, the expected weight of the unborn child) the tactics for managing pregnancy and the upcoming birth are decided.
Doctors strongly recommend that women limit physical activity (exclude heavy lifting and, if possible, climbing stairs) and spend as much time as possible in a lying position. Multivitamin complexes, calcium supplements, and extensive bandaging of the pelvic area are also prescribed.
Until the birth itself, pregnant women should:
- attend special exercise therapy courses;
- wear a pelvic band;
- eat foods that are rich in vitamins and microelements;
- try to avoid prolonged sitting.
In more severe cases, women are hospitalized in the department of pathology of pregnant women and are constantly under the supervision of a gynecologist and traumatologist, and also receive specialized medication and physiotherapeutic treatment.
The choice between natural birth or cesarean section depends on the degree of divergence of the symphysis, the general condition of the pregnant woman (whether there is gestosis or other pathology), as well as on the size of the fetus. In the case of the first degree of symphysitis, normal fetal weight, absence of early and late gestosis, as well as exacerbation of any underlying diseases in the mother, childbirth is possible physiologically. In other cases, doctors tend to favor a caesarean section.
Prevention of the development of symphysitis
Every planning or already pregnant woman needs to know how to prevent symphysitis, even if she has no health problems or family history.
- Diversify your diet with foods containing sufficient amounts of minerals and calcium.
- During seasons of hypovitaminosis, as well as after infections, take vitamin complexes.
- Take prophylaxis with bifidobacteria and lactobacilli.
- Take regular walks in the fresh air.
- You can go in for sports or exercise therapy (swimming, running, special gymnastics).
- Be sure to watch your posture.
During pregnancy, a lot of changes occur in a woman’s body, changes aimed at bearing a child, childbirth and feeding. The pelvis of a pregnant woman is a ring that includes the sacrum, coccyx, as well as the ischium, pelvic and pubic bones, which are located symmetrically. The pubic bones are connected to each other by the pubic symphysis, which is otherwise called the “articulation of the pubis.”
Ultrasound of the symphysis pubis
Ultrasound of the symphysis pubis is aimed at examining this particular area. This diagnostic method allows you to determine the presence of inflammatory or other processes that cause discomfort to the pregnant woman and complicate bearing a child.
When is an ultrasound of the symphysis pubis prescribed?
During pregnancy, an ultrasound of the symphysis pubis is usually prescribed when there are complaints of discomfort. Most likely, the doctor will refer you for diagnostics if the following symptoms appear:
- sharp pain when walking, which radiates to the leg, groin, and lower back;
- increased pain when climbing stairs, bending, but the pain goes away during rest;
- crunching sounds are heard when palpating the pubis;
- A pregnant woman walks in small steps, which are called a “duck walk.”
However, there are a number of situations in which the doctor will refer a woman during pregnancy even without the manifestation of unpleasant symptoms. It will be necessary to undergo the procedure if there is an injury with deformation of the pelvic joints or the pregnant woman suffers from kyphoscoliosis. It is also necessary for those with a narrow pelvis to undergo an examination if the fetus is large enough, its malpresentation is determined, and there was also a rupture of the pubic ligaments during a previous pregnancy.
Ultrasound of the symphysis pubis during pregnancy
If the doctor decides that the symphysis pubis needs to be examined by ultrasound, it is worth finding out what such a diagnosis will show. Namely:
- the presence of an inflammatory process;
- softening of the joint;
- rupture or stretching;
- swelling;
- expansion of the bones of the pubis.
Do you need any preparation for the procedure?
If you do not know how an ultrasound of the symphysis pubis is performed during pregnancy and how to prepare, you should know that no preparatory measures are needed. The procedure is completely safe and does not cause any discomfort. You don’t have to worry about harm to the health of the baby and the patient. This is confirmed by the fact that doctors do not use any additional protection, and in one day they conduct up to ten such studies.
How is an ultrasound of the symphysis pubis performed?
Before going to the doctor, you should find out how an ultrasound of the symphysis pubis is performed during pregnancy. A pregnant woman only needs to make an appointment and come to the doctor at the appointed time. To begin the procedure, you need to remove clothes from the area being examined - lift your jacket and lower your pants. The doctor applies a special gel to the area of the body being examined, which is necessary to eliminate air between the body and the device. The study takes about 10 minutes, and sometimes even less.
Decoding the results
Finding out who performs the ultrasound procedure of the symphysis pubis is the same as finding out which specialist will do the decoding. Examining organs using ultrasound and drawing up conclusions is the task of a sonologist. The professional first carefully examines the condition of the joint on the screen, after which he writes a conclusion, describes the progress of the study, attaches a picture to it and gives the results to the patient.
What is the pubic symphysis?
The pubic symphysis is the vertical articulation of the pubic bones. Sometimes during pregnancy - at the beginning of the second or third trimester - pain appears in this area, which is called symphysitis. The occurrence of pain is explained by the divergence of the symphysis pubis; it is not difficult to detect it on an ultrasound. In this case, careful monitoring of the pregnant woman’s health is necessary, since the condition is fraught with rupture of the joint. Depending on how many mm the bones diverge, several degrees of the disease are determined. Namely:
- 8-9 mm – 1st;
- 10-20 mm – 2nd;
- more than 20 mm – 3rd.
It is necessary to take measures if the discrepancy of the bones is more than 10 mm. If the discrepancy is less than 10 mm, the pregnant woman’s pelvis is of normal size, and the fetus is small, childbirth will occur naturally.
How to avoid the occurrence of symphysiopathy?
The occurrence of this disease is not fully understood. In order not to think about how the ultrasound procedure of the symphysis pubis is performed, it is worth familiarizing yourself with a number of general recommendations. These include the following:
- A pregnant woman needs to eat more foods that contain calcium;
- It is best to take vitamin complexes that will enrich the body with essential useful substances;
- you need to take medications with bifidobacteria and lactobacilli;
- moderate physical activity is indicated;
- A pregnant woman should take up swimming, which has a beneficial effect on the general condition of the body;
- It is useful to regularly walk in the fresh air;
- You cannot spend a lot of time in the same position, and you also need to monitor your posture.
