A Case Report of Single Umbilical Artery Combined with Fetal Bladder Exstrophy in Singleton Pregnancy and Related Literature Review

Abstract

Background Single umbilical artery is the most common umbilical cord dysplasia. According to prenatal ultrasonographic studies, single umbilical artery may be present alone or in association with other fetal abnormalities. The current mainstream theories about the mechanism of single umbilical artery leading to abnormal fetal development are the theories of “vitelline vascular steal” and “disturbance of embryo caudal development”. In addition, bladder exstrophy is mainly characterized by the exposure to bladder mucosa. So far, the exact pathogenesis of bladder exstrophy is unclear. The bladder is a part of the cloaca; thus, some scholars believe that bladder exstrophy and cloacal exstrophy should be regarded as a disease spectrum for research. These scholars believe that both cloacal exstrophy and bladder exstrophy belong to cloacal dysplasia, therefore these two diseases should be included in the same disease spectrum in order to explore their pathogenesis. Previous literatures have reported that single umbilical artery is associated with cloacal exstrophy. If bladder exstrophy and cloacal exstrophy are regarded as the same disease spectrum, then we can speculate that the single umbilical artery should have the probability of being accompanied by bladder exstrophy at the same time. However, as of now, there are no reports of bladder exstrophy associated with single umbilical artery in singleton pregnancy. Case presentation: For the first time, we report a rare case of fetal bladder exstrophy with single umbilical artery in single pregnancy. This patient underwent targeted color Doppler ultrasound and fetal MRI for diagnosis. After the diagnosis was confirmed, the patient was scheduled for a multidisciplinary discussion. Ultimately the patient opted for induced fetal demise. Conclusions Our report is the first finding of single umbilical artery combined with bladder exstrophy in a singleton pregnancy. Accordingly, our case enhances the evidence that cloacal exstrophy and bladder exstrophy should be treated as the same disease spectrum, and it adds to the richness of the disease spectrum caused by single umbilical artery. In addition, we conducted a literature review on the diagnostic progress of single umbilical artery combined with bladder exstrophy, hoping to provide useful references for the diagnosis of this disease.