Pelvic organ prolapse in the neonate: report of two cases and review of the literature

Abstract

Pelvic organ prolapse (POP) in the new-born baby is a rare though well-acknowledged clinical condition. We present two cases of complete utero-vaginal prolapse in new-born babies. Both infants were otherwise healthy and neurologically normal in their clinical presentation and evaluation. The prolapse was successfully managed with a non-surgical approach. There appears to be two distinct forms of POP in newborns based on the available literature. There are those that occur in newborns with spina bifida (77 % of cases) and those that occur in neurologically intact newborns (23 %). The management of these two types are distinctly different and are discussed in greater detail in this report.

Uterovaginal Prolapse in a Newborn with Meningomyelocele: Case Report

“…It is thought that abnormal innervation and the resulting atrophy of the pelvic floor musculature might be the cause of uterovaginal prolapse in newborns with severe forms of meningomyelocele, whereas others who are neuroanatomically normal might have other undefined etiologies. 3,4 Conservative or surgical interventions must be undertaken as soon as possible to prevent possible vaginal injury and to help protect fertility in newborns with uterovaginal prolapse. 4,5 According to the literature, several techniques may be carried out in reduction of prolapsed pelvic organs, such as conservative methods including simple digital reduction, the use of hypertonic saline packs and pessaries, or urogenital surgical methods including labial or vaginal fusion with suturing and abdominal sacrocolpopexy if the mass is not reducible, or even hysterectomy.…”

“…3e6 In neuroanatomically normal newborns with uterovaginal prolapse, simple digital reduction is generally sufficient, whereas those with meningomyelocele have high recurrence rates of uterovaginal prolapse even when they are treated with urogenital surgical methods. 3 Because the abnormal innervation of the pelvic floor musculature due to the NTD results in poor pelvic muscle tone and subsequent prolapse of pelvic organs, these patients benefit from surgical repair of the meningomyelocele, which improves the tone of the musculus levator ani. 3 On the basis of the past experiences described in the literature, coexistence of meningomyelocele and uterovaginal prolapse in our patient in the setting of ineffective digital reduction and subsequent reprolapse without any improvement have led us to correction of the NTD in advance and to subsequent further planning of urogenital procedures if necessary.…”

Spontaneously resolved uterine prolapse in a neonate with spina bifida

“…1 Up to 2015, 69 cases have been reported. 2 Most of the cases are associated with spina bifida either occult or with meningomyelocele. In Henn et al's 2 study, 77% of the cases were associated with spina bifida.…”

“…The first case with uterine prolapse was reported by Conovius 1 in 1723 and to date most of the reported cases were associated with spina bifida. 2 The main reason in spina bifida is impaired innervation of pelvic floor. Conservative management such as manual reduction or insertion of a Foley catheter to vagina or surgical management may be options in treatment.…”

Uterovaginal prolapse following suspected sexual abuse to a child: a case report

“…It can be congenital or acquired. Both forms are quite rare in children with research articles describing more of the congenital presentations in children, the congenital presentation being more frequent than the acquired and usually associated with spinal cord defects [3,4]. The etiology of the congenital form is due to congenital weakness of the pelvic floor or abnormal nerve supply to the pelvic floor [5].…”