MR imaging of pubic symphysis after uncomplicated vaginal delivery and planned caesarean delivery in the first postpartum week


      • Pubic bone marrow edema in the first week after childbirth can be a normal finding.
      • Pubic bone marrow edema is present in 3 of 4 women in the first postpartum week unrelated to the delivery mode.
      • Pubic bone marrow edema after planned caesarean delivery is most likely a result from mechanical stress during pregnancy.



      To compare changes in the pubic symphysis between women with vaginal delivery and women with caesarean sections within the first postpartum week.

      Materials and methods

      After institutional review board approval 30 healthy women were prospectively examined with MRI (transverse STIR-sequence) three days after delivery. 17 women with vaginal delivery (mean age 33.2 ± 4 years) and 13 with caesarean delivery (35.2 ± 5.6 years) were compared by two musculoskeletal radiologists. Bone marrow edema (location and extent), fluid in the joint gap, joint space width and stress fractures were assessed.


      Prevalence of bone marrow edema was high and not different between groups (13/17 (76.5%) vaginal deliveries) and 10/13 (76.9% caesarean deliveries) for reader 1 (p = 0.992) and 14/17 (82.4%) and 10/13 (76.9%) for reader 2 (p = 0.762). Size of bone marrow edema was not statistically significantly different for both readers (results reader 1: right side 2.5 ± 3.3 mm vs. 6.3 ± 7.3 mm, p = 0.300; left side 3.4 ± 4.1 mm vs. 4.1 ± 4.6 mm, p = 0.837). Fluid in the joint was seen in 4/17 (23.5%) vs. 2/13 (15.4%) (p = 0.580) for reader 1 (similar for reader 2). Joint space width did not differ between groups (2.6 ± 0.7 mm vs. 3.1 ± 1.2 mm, p = 0.198). Pubic symphysis diastasis (joint space width > 10 mm) was not observed. Interreader agreement for these parameters was substantial to almost perfect (0.671–0.984, kappa values/intraclass correlation). Reader 1 found no stress fractures, while reader 2 suspected 1 stress fracture on a right pubic bone in a woman after caesarean delivery.


      Pubic bone marrow edema is present in 3 of 4 women in the first postpartum week unrelated to the delivery mode.


      BME (bone marrow edema), ICC (intraclass correlation coefficient), MRI (magnetic resonance imaging), STIR (short-tau inversion recovery)


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