Successful pregnancy in patients with exstrophy–epispadias complex: A University of Washington experience

Dy, Geolani W.; Willihnganz-Lawson, Katie H.; Shnorhavorian, Margarett; Delaney, Shani; Oelschlager, Anne Marie Amies; Merguerian, Paul A.; Grady, Richard W.; Miller, Jane L.; Cheng, Edith

doi:10.1016/j.jpurol.2015.04.019

Cited by 33 publications

(29 citation statements)

References 12 publications

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“…In this patient population, 4 patients were noted to have adhesive disease that required modification of the standard surgical technique to avoid injury to bladder and/or bowel. 11,17,19,40,41 This modification of a standard surgical cesarean section has also been described in other complex pelvic anomalies such as bladder exstrophy. 41 In 1 case, a transvesical cesarean section was performed because of multiple adhesions and abnormal position of the bladder.…”

Section: Pelvic Adhesionsmentioning

confidence: 97%

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: Pelvic Adhesionsmentioning

confidence: 97%

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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Section: Findings and Recommendationsmentioning

confidence: 99%

“…66, 67 Reports point to increased risk of UTI, early delivery and Cesarean birth. 66 One observational study of pregnancy in women with cloacal/exstrophy reported a 100% Cesarean birth rate. 66 If these women had had previous urological or gastrointestinal surgery, they may be at further risk during Cesarean delivery.…”

Section: Findings and Recommendationsmentioning

confidence: 99%

“…66 One observational study of pregnancy in women with cloacal/exstrophy reported a 100% Cesarean birth rate. 66 If these women had had previous urological or gastrointestinal surgery, they may be at further risk during Cesarean delivery. However, the exact prevalence of pregnancy complications and negative outcomes by CGC type are unknown, and factors that may mediate risk are poorly understood.…”

Section: Findings and Recommendationsmentioning

confidence: 99%

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Research Needs for Effective Transition in Lifelong Care of Congenital Genitourinary Conditions: A Workshop Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases

Hsieh

Wood

Dicianno

et al. 2017

Urology

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Over the last five decades, healthcare advances have yielded quantum improvements in life expectancy for individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related healthcare issues, while adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This manuscript outlines identified research needs.

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“…4 Less than 10% of women with cloacal and bladder exstrophy have been reported to have pregnancies, and these pregnancies have been complicated by new onset or worsening of recurrent UTI, uterine prolapse, and urinary incontinence. 4,8 Matthews et al described a case of pregnancy in a patient with a history of cloacal exstrophy repaired initially by urinary diversion. The pregnancy was complicated by perforation of Koch's pouch during cesarean section, postpartum uterine prolapse, fecal incontinence, and urinary incontinence from the urinary diversion.…”

Section: Urologymentioning

confidence: 99%

Management of pregnancy in patients with exstrophy-epispadias sequence: a case series and literature review

Gnade

Williams

Kowalski

et al. 2017

Proc Obstet Gynecol

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Successful pregnancy in patients with exstrophy–epispadias complex: A University of Washington experience

Cited by 33 publications

References 12 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

Research Needs for Effective Transition in Lifelong Care of Congenital Genitourinary Conditions: A Workshop Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases

Management of pregnancy in patients with exstrophy-epispadias sequence: a case series and literature review

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