Fetal ascites and hydrometrocolpos due to persistent urogenital sinus and cloaca: a rare congenital anomaly and review of literature

Nigam, Aruna; Kumar, Manisha; Gulati, Shilpa

doi:10.1136/bcr-2013-202231

Cited by 22 publications

(13 citation statements)

References 10 publications

(8 reference statements)

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“…Gestational age was noted in 12 of the pregnancies that resulted in a live birth. Most of these pregnancies (8/12) were delivered prematurely, with the average gestational age of 32.5 (range, [28][29][30][31][32][33][34][35][36] weeks. These premature deliveries were most commonly the result of spontaneous premature rupture of membranes (PPROM) and not medically indicated deliveries.…”

Section: Resultsmentioning

confidence: 99%

“…32 Very rarely, because of the outflow obstruction, urine refluxes through the fallopian tubes in the abdominal cavity and leads to fetal urinary ascites. 33 After birth, the hydrocolpos typically needs to be drained to avoid urinary outlet and ureteral obstruction. 34 Currently, there is no consensus on the best approach to the initial management of hydrocolpos.…”

Section: Fetal Ascites/hydrocolposmentioning

confidence: 99%

See 1 more Smart Citation

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

Vilanova-Sánchez

McCracken

Halleran

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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a b s t r a c tPatients born with complex anorectal malformations often have associated M€ ullerian anomalies, which might affect fertility and obstetrical outcomes. Other vertebral-anorectal-tracheoesophageal-renal-limb associations, such as renal or cardiac anomalies, could also affect pregnancy intention, fertility rates, and recommendations about mode of delivery or obstetrical outcomes. Associated conditions present at birth, like hydrocolpos, could also potentially affect fertility. Depending on the complexity of the anomaly, primary reconstruction might include vaginoplasty, vaginal interposition, perineal body reconstruction, and extensive pelvic dissection. After the initial reconstruction, patients might have multiple additional surgeries for stoma reversal, bladder augmentation, and creation of conduits, all with potential for pelvic adhesions. Pregnancy intention, fertility rates, mode of delivery, and obstetrical outcomes data are limited in this patient population, making it challenging to counsel patients and their families. We sought to evaluate all available literature in an attempt to better counsel families. A PubMed literature search was undertaken to review this topic. Search terms of "cloaca," "anorectal malformation," "pregnancy," "cloacal exstrophy," "vaginal delivery," and "cesarean section" were used and citation lists from all identified articles were checked to ensure that all possible articles were included in the review. We also outline comorbidities from the fetal period to adulthood that might affect reproductive health. Of the articles on anorectal and cloacal anomalies, 13 reports were identified that covered obstetrical outcomes. They were in patients with previous anorectal malformation, cloaca, and cloacal exstrophy repair. Twenty-four pregnancies were reported in 16 patients. Two ectopic pregnancies, 5 spontaneous miscarriages, 1 triplet pregnancy, and 16 singleton pregnancies were reported with a total of 19 live births. Regarding the method of conception, 15/18 pregnancies occurred spontaneously and 3/18 were via assisted reproductive technology with in vitro fertilization. There were 19 live births, of which at least 8 were preterm. M€ ullerian anatomy was reported in 8 of 13 articles. Only 2 patients underwent vaginal delivery (1 patient with repaired cloaca malformation had an operative vaginal delivery and 1 patient with repaired imperforate anus with rectovaginal fistula had a normal spontaneous vaginal delivery). The remaining patients all underwent a cesarean section. There were no reported cases of maternal mortality, and maternal morbidity was limited to recurrent urinary tract infections and worsening chronic kidney disease. There is a paucity of information regarding obstetrical outcomes in adult anorectal and cloaca patients. However, patients with previous cloacal repairs have achieved pregnancy spontaneously, as well as with in vitro fertilization. Patients with repaired cloacal malformations are at increased risk of preterm birth and cesarean delivery. Most p...

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Section: Resultsmentioning

confidence: 99%

Section: Fetal Ascites/hydrocolposmentioning

confidence: 99%

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

Vilanova-Sánchez

McCracken

Halleran

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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“…[6][7][8][9] It can be associated with peritonitis from bowel perforation due to compression or fetal ascites. [10,11] Diagnosis is challenging which delays management. [12,13] Ultrasound and MRI are useful studies in the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Early Diagnosis and Successful Treatment of Congenital Huge Hydrometrocolpos Secondary to Low Transverse Vaginal Septum with Obstructive Symptoms

Ayichew¹,

Tegegne²,

Melesse³

2019

AJP

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Obstructive congenital anomalies of the female reproductive tract are rare and usually noticed during adolescent period for failure to see menses with cyclic abdominal pain, abdominal mass and local compressive symptoms. It is very rare for such cases to be symptomatic during early childhood from mucous collection. Congenital hydrometrocolpos (an accumulation of watery fluid in the uterus and vagina) that occurs during fetal period is a very rare condition, only with some case reports. The diagnosis is challenging and usually made late which delays the management resulting poor outcome from local compressive symptoms. We present a case diagnosed with huge congenital hydrometrocolpos secondary to low transverse vaginal septum using ultrasound by experienced radiologist and meticulous genital examination in a 5 day old neonate who had abdominal distention and difficult to pass urine since birth where incision of the septum transvaginally and drainage of the fluid was done to relieve symptoms with successful outcome.

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“…Fetal ascites in these cases was due to fetal urine draining through falloppian tubes into the abdomen as a result of vesico-vaginal fistula and distal vaginal atresia. [8][9][10] Endoscopical drainage of internal genitalia allows an urgent miniinvasive decompression of the hydrometrocolpos and of the upper urinary tract dilatation, thus to permit a recovery of the general conditions of the female neonated, allowing, by the way, a detailed study of these complex abnormalities. Last but not least, neonatal diagnostic/operative cystoscopy permits a miniinvasive diagnosis in the very rare neonatal bladder mass.…”

Section: Discussionmentioning

confidence: 99%

Operative cystoscopy in the neonatal period

et al. 2016

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Aim of the study is to report the experience in the last three years about endourological treatment of newborns affected by genito-and urinary malformation, implying critical urinary tract dilatation and bladder mass requiring a neonatal operative management. Sevenfour males and three female -patients were treated cystoscopically during the neonatal period. Three newborns with a posterior urethral valves (PUV), underwent a successful ablation of PUV. In a male with infected persistent large mullerian duct and subsequent acute urinary retention, a cystoscopically-assisted catheterization was performed. Two females, one with cloaca and the other with high persistent urogenital sinus and massive associated hydrometrocolpos underwent a cystoscopical drainage of the vagina and a positioning of a balloon catheter into the bladder. Another female with a bladder mass had a endoscopical biopsy. Thanks to modern neonatal operative urethrocystoscope, today is possible to treat early many pathological genito-urinary conditions in newborns.

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Fetal ascites and hydrometrocolpos due to persistent urogenital sinus and cloaca: a rare congenital anomaly and review of literature

Cited by 22 publications

References 10 publications

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

Early Diagnosis and Successful Treatment of Congenital Huge Hydrometrocolpos Secondary to Low Transverse Vaginal Septum with Obstructive Symptoms

Operative cystoscopy in the neonatal period

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