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PREGNANCY FOLLOWING REPAIR OF ANAL AND VAGINAL ATRESIA AND BLADDER EXSTROPHY

From the Divisions of Obstetrics and Maternal-Fetal Medicine, Hutzel Hospital, and the Department of Gynecology and Obstetrics, Wayne State University School of Medicine, Detroit, Michigan

Abstract

Pregnancy following surgical correction of bladder exstrophy with anal and partial vaginal atresia is extremely rare. These defects, plus the absence of the pubic symphysis and anatomic deficiencies of the urogenital diaphragm, pose extraordinary obstetric and surgical problems. This report is based on the experience of a 21-year-old patient who had a successful pregnancy following curative repair of these defects. Progressive uterine prolapse occurred during pregnancy to the extent that at the time of delivery the presenting part of the fetus was below the pelvic outlet. Cesarean section was performed at 36 weeks' gestation when the cervix was 4 cm dilated with a single footling breech presentation. Postpartum surgical management of the uterine and vaginal prolapse is described.