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

Abstract

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.

Figure 1

Antenatal ultrasound of fetus showing bilobed cystic structure in the lower abdomen with ascites.

Figure 2

Antenatal ultrasound of fetus showing bilobed cystic structure in the lower abdomen with dilated renal calyces.

Figure 3

External appearance of fetus showing enlarged abdomen, short limbs and congenital talipes varus.

Figure 4

Enlarged clitoris and labia with no perineal opening.

Figure 5

Fetal autopsy showing enlarged uterus and tubes with ascites.

Figure 6

Demonstration of infant feeding tube going into the cut dome of the bladder and coming out through vaginal incision.