Characteristics of fetal physiological and pathological uterine effusion observed on prenatal ultrasonography: a case report.

BACKGROUND: The prenatal detection rate of fetal uterine effusion is very low, and current case reports mainly focus on pathological hydrometrocolpos. We presented two cases of fetal physiological uterine effusion with different ultrasonic characteristics and compared them with one case of hydrometrocolpos with the hope of identifying strategies to reduce misdiagnosis of fetal uterine effusion. CASE PRESENTATION: This paper reports the cases of two female fetuses with abnormal pelvic echoes in the third trimester, referred to a tertiary center to be screened for suspected pelvic teratoma and cystic mass, respectively. Ultrasound consultation revealed fetal uterine effusion. The two fetuses were delivered at our hospital after a full term. Re-examining the uterus and adnexa of the neonates revealed that the uterine effusion had subsided naturally. Another female fetus had a large cystic mass in the pelvic cavity in the third trimester, and prenatal examination indicated fetal hydrometrocolpos. The fetus was delivered at our hospital after a full term. The hydrometrocolpos existed even after birth. After consultation with a neonatal surgeon and gynecologist, the newborn was diagnosed with congenital imperforate hymen with hydrometrocolpos. Hymen puncture and open drainage led to a good prognosis. CONCLUSIONS: Prenatal ultrasonography plays an important role in diagnosing and differentiating between physiological and pathological fetal uterine effusion. It can help reduce misdiagnoses that can lead to incorrect clinical decisions.

Rare case of pseudohypoaldosteronism in a neonate secondary to congenital hydrometrocolpos.

Pseudohypoaldosteronism (PHA) due to obstructive uropathy, urinary tract infections and congenital urogenital malformations has been reported in the literature; however, there are no reports of PHA associated with hydrometrocolpos due to a common urogenital tract. Hydrometrocolpos is a condition resulting in distension of the vagina and uterus due to accumulation of secretions (other than blood), caused by increased oestrogenic stimulation and vaginal outflow obstruction. We report on a neonatal case of PHA caused by recurrent hydrometrocolpos presenting with vomiting and poor weight gain. There was significant hyponatraemia, hyperkalaemia, and anaemia requiring medical stabilisation prior to surgery. The mechanism by which PHA occurs in obstruction involves renal tubular dysfunction due to pressure from hydronephrosis and the release of intrarenal cytokines. In addition, there is an immature or resistant renal tubular responsiveness to aldosterone during infancy. Clinicians should be aware of this uncommon but serious presentation.

Fetal hydrometrocolpos and congenital imperforate hymen: Prenatal and postnatal imaging features.

Congenital imperforate hymen is probably the most common obstructive anomaly of the female reproductive tract. The accumulation of fluid in the genital tract leads to a distended uterus and vagina, causing hydrometrocolpos. Prenatal diagnosis of fetal hydrometrocolpos is uncommon, with only 22 cases reported in the literature and only a few cases of prenatal imaging of this condition available to date. The main ultrasound finding is a fetal pelvic mass posterior to the bladder and anterior to the rectum. We present the case of a 37-week female fetus with a fetal pelvic mass detected in a routine obstetric ultrasound examination, and the correlation between the prenatal and postnatal findings.

Urinary ascites due to persistent urogenital sinus: A case report and review of literature.

BACKGROUND: Persistent urogenital sinus is one of the rare urogenital anomalies, which commonly presents as hydrometrocolpos. Fetal urinary ascites as a presentation of persistent urogenital sinus is extremely rare. CASE REPORT: We report on a preterm infant with antenatal diagnosis of hydrometrocolpos and massive urinary ascites secondary to urogenital sinus without any bladder or renal abnormalities. CONCLUSION: This case report emphasizes the importance of maintaining a high index of suspicion in the diagnosis of persistent urogenital sinus especially in infants presenting with urinary ascites along with hydrometrocolpos.

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

Fetal ascites can occur due to many heterogeneous disorders. Its association with hydrometrocolpos because of persistent urogenital sinus and cloaca is extremely rare. A 29-year-old primigravida presented at 32 weeks of gestation with ultrasonographic evidence of fetal ascites, a cystic pelvic mass, hydronephrosis and oligohydramnios. Fetal ascites in this case was due to fetal urine draining through fallopian tubes into the abdomen as a result of vesicovaginal fistula and distal vaginal atresia. The antenatal ultrasound results along with autopsy findings are discussed. Though rare, a persistent urogenital sinus is to be suspected in isolated fetal ascites cases where the viral tests are negative and there is no evidence of cardiac anomalies as this is a treatable anomaly if diagnosed at early gestational age.

Herlyn-Werner-Wunderlich syndrome--timely diagnosis is important to preserve fertility.

BACKGROUND: Herlyn-Werner-Wunderlich syndrome is an urogenital malformation with uterus didelphys and obstructed hemivagina with ipsilateral renal agenesis. Most of these patients present after the onset of menstruation. We describe two cases diagnosed too late to prevent the complications. CASE: The first patient presented with acute abdomen one year after the onset of menstruation and had salpingectomy due to pyosalpinx. The blind hemivagina was not recognized and she had severe endometriosis. She underwent hysterectomy 8 years later. The second patient presented with foul smelling vaginal discharge when she was 21 years old. She had a simple vaginal septum resection. SUMMARY AND CONCLUSION: In the presence of uterine cavities in a regularly menstruating girl with dysmenorrhea, the presence of both kidneys should be checked. When unilateral renal agenesis and uterus didelphys coexist the first thing that we should remember is to confirm or refute the presence of a blind vagina.

Herlyn-Werner-Wunderlich syndrome consisting of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis in a newborn.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of Müllerian duct anomalies consisting of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Patients with HWW syndrome are usually asymptomatic until menarche, when they present with acute lower abdominal pain. Here we report a case of a female newborn with right renal agenesis diagnosed during the pregnancy. The patient presented with a protruding mass over the vaginal introitus that was associated with an obstructed hemivagina and uterine didelphys.

Ultrasonographic diagnosis of congenital hydrometrocolpos in prenatal and newborn period: a case report.

Our purpose is to present the ultrasonographic findings of a rare case of prenatally and postnatally congenital hydrometrocolpos secondary to imperforate hymen. By ultrasonography (US) at 38 weeks of gestation, a retrovesical, 60 x 43 mm pelvic cystic mass, was demonstrated in a female fetus. After delivery, US of the newborn revealed a 77 x 60 mm retrovesical, pear-shaped cystic structure with internal echoes, interpreted as congenital hydrometrocolpos. Mild pelvicaliectasis in the left kidney was associated. At physical examination imperforate hymen was detected and a hymenotomy was done. After the hymenotomy, complete regression of the hydrometrocolpos and of the left renal pelvicaliectasis was demonstrated sonographically.

Prenatal sonographic diagnosis of fetal persistent urogenital sinus with congenital hydrocolpos.

We report a case of persistent urogenital sinus with hydrocolpos and associated renal anomalies diagnosed prenatally at 30 weeks' gestation. The prenatal findings were confirmed on postnatal ultrasonography and genitogram with voiding urethrogram. The imaging features and a review of the literature are discussed. The possibility of hydrometrocolpos secondary to urogenital sinus should be considered on prenatal sonography in the presence of a presacral cystic mass with clear urine or turbid contents and a fluid-debris level (cervical or vaginal secretions). Because the prognosis and neonatal management of isolated hydrocolpos (which usually resolves spontaneously) differ greatly from those of hydrocolpos associated with a cloacal malformation, it is important to diagnose prenatally any associated anomalies in order to allow optimal postnatal management.

Hidrocolpos neonatal / Neonatal hydrocolpos

Se presenta el caso de un recién nacido del sexo femenino, raza blanca, hija de matrimonio no consanguíneo e historia familiar negativa de defectos congénitos, a quien se detectó, a las 62 h de nacida, una tumoración de aproximadamente 2 cm de diámetro, de aspecto deslustrado, renitente, que protruía a través del introito vaginal al llanto. Se realizó valoración conjunta con especialistas en cirugía pediátrica, urología pediátrica, ginecoobstetricia, radiología, genética clínica y cardiología, y se iniciaron los estudios necesarios. Se diagnosticó un hidrocolpos neonatal por himen imperforado. Se realizó una himenotomía al cuarto día de vida y se evacuó abundante cantidad de secreción seromucosa. Se dio el alta a la paciente con 16 días y evolución satisfactoria. Se realiza una caracterización clínica de la patología y se ofrece una revisión actualizada sobre el tema. Se presentan ademßs fotografías del caso(AU)

This is the case of a white female newborn, child of a non-consanguinity married couple and a with negative family history of congenital defects in whom at 62 hours of born a dull, renitent tumor of almost 2 cm diameter, and protruding through the vaginae introitus when she cried was detected. Authors made a joint assessment with specialists in pediatric and urology surgery, gynecology-obstetrics, radiology, clinical genetics and cardiology. A hymenotomy was performed at 4 days of life voiding an abundant amount of seromucous secretion. Patient was discharged at 16 days and a satisfactory course. A clinical characterization of pathology was made offering an updated review on thus matter. Photographies from this case are showed(AU)

Prenatal ultrasonographic features of persistent urogenital sinus with hydrometrocolpos and ascites.

OBJECTIVE: Hydrometrocolpos is a rare congenital disorder very rarely reported on prenatal sonography. In this study we report a persistent urogenital sinus with hydrometrocolpos and ascites at 24 weeks of gestation. CASE: Detailed ultrasonographic examination revealed female fetus with pelvic mass measured as 60 x 70 x 80 mm, anterior to sacral bone and inferior to bladder, and ascites, ureterocele, hydroureter, hydronephrosis but normal amniotic fluid. Further examination showed that cervical canal and uterine cavity was in continuation with the pelvic mass and dilatation of uterine tubes implicated hydrometrocolpos. Physical examination of the neonate revealed a single anterior opening at perineum and a patent anus but no visible urethral orifice. A voiding cystourethrogram demonstrated a urethrovaginal fistula. The neonate underwent ureteroneoostomy and was discharged on day 10 for follow-up and final repair. CONCLUSION: Prenatal ultrasonographic diagnosis of hydrometrocolpos in our case prevented unnecessary interventions and allowed early neonatal treatment.

Prenatal diagnosis of imperforate hymen with hydrometrocolpos.

Imperforate hymen is one of the most simple and most common anomalies in the female genital organs, occurring in 0.1% of girls born at term. Some are recognized because of mucocolpos at birth, but the diagnosis is usually not detected before puberty. Rarely, obstetric sonography may prenatally detect imperforate hymen due to presentation of hydrocolpos or hydrometrocolpos in the fetus if fetal cervical and vaginal secretions accumulate in response to circulating maternal estrogens. Nonetheless, reports of prenatal ultrasound diagnosis of hydrometrocolpos are still very rare. In this article we report a prenatally diagnosed of imperforate hymen with hydrometrocolpos.

The role of dynamic magnetic resonance urography in complex neonatal hydrometrocolpos.

Urinary hydrometrocolpos is rarely diagnosed and is most often attributed to a persistent urogenital sinus or a cloaca. We report the case of a neonate in which the use of dynamic MRI allowed accurate preoperative diagnosis of urinary hydrometrocolpos secondary to ectopic drainage of a small left pelvic kidney, associated with a bicornuate uterus.

Mucocolpos associated with bladder exstrophy: a case report.

INTRODUCTION: We present the first reported case demonstrating an association of mucocolpos and bladder exstrophy. MATERIALS: A term baby girl presented with bladder exstrophy and underwent a successful primary bladder closure and ureteral reimplantation. Subsequently, she presented with a fluid-filled pelvic mass which was found to be a mucocolpos. RESULTS: Surgical drainage of the collection was required. CONCLUSION: Mucocolpos should be considered in the differential diagnosis of a pelvic mass in a patient with bladder exstrophy.