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Review
. 2025 May;311(5):1467-1474.
doi: 10.1007/s00404-025-08004-8. Epub 2025 Apr 2.

Isolated hydrometrocolpos and cloacal malformation: can we prenatally distinguish them?-A case report and literature review

Meylign Long #  1   2 , Kaiyu Fu #  1 , Jie Ruan  3
Affiliations
Review

Isolated hydrometrocolpos and cloacal malformation: can we prenatally distinguish them?-A case report and literature review

Meylign Long et al. Arch Gynecol Obstet. 2025 May.

Abstract

Background: Hydrometrocolpos (HMC) is a rare prenatal ultrasound abnormality, presenting in two distinct types: urinary-type and secretory-type. The urinary variation is intricately linked to cloacal malformation (CM), thereby posing a heightened risk of perinatal adverse events. Additionally, children affected by this type often face long-term challenges that impact their quality of life. Therefore, predicting the presence of CM in HMC fetuses is of great clinical significance.

Case presentation: We present a case involving hydrometrocolpos accompanied by oligohydramnios. Prenatally, the condition was strongly indicative of CM based on imaging manifestations and intrauterine procedures, a suspicion that was later confirmed through postnatal autopsy.

Conclusion: Due to the extremely low incidence of HMC, current literature primarily consists of case reports, and there are no studies that comprehensively analyze the prognosis of the disease. This research fills this gap by statistically analyzing the present case as well as 164 prenatal HMC cases reported in the previous literature. Gestational age (GA) at initial detection, the presence of fetal ascites, urinary tract dilatation, anorectal imaging abnormalities, and Müllerian anomalies are meaningful predictors of CM in HMC fetuses. Intrauterine procedures can be used to preserve organ function in complete lower urinary tract obstruction and oligohydramnios secondary to HMC. In addition, biochemical analysis of HMC fluid can differentiate between urinary-type HMC and secretory-type HMC. This study provides valuable insights into the prognostic factors and management strategies for HMC, which could guide clinical decision-making in prenatal care.

Keywords: Cloacal malformation; Fetal ascites; Hydrometrocolpos; Intrauterine procedures.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval and consent to participate: Approval was obtained from the Ethics Committee of West China Second Hospital, Sichuan University. Informed consent was obtained from all participants. All methods were performed in accordance with the Declaration of Helsinki. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
Sonographic image demonstrating HMC posterior to the fetal bladder (B), with fluid accumulation in the vagina (V) and uterus (U). No amniotic fluid is observed around the fetus
Fig. 2
Fig. 2
MRI of HMC (A: coronal image; B: sagittal image). A gourd-shaped cyst in the lower fetal abdomen demonstrated high signal on T2-weighted images. MRI can show the location information of the cyst
Fig. 3
Fig. 3
Appearance of the perineum of the fetus (long arrow: common urogenital orifice; short arrow: anterior anus)
Fig. 4
Fig. 4
Fetal autopsy. A enlarged uterus (U), vagina (V), bladder (B) and slim fallopian tubes (arrow) can be seen
Fig. 5
Fig. 5
Logistic regression model and the receiver operating characteristic (ROC) curves for predicting CM in HMC fetuses with the GA at initial detection and imaging variables
See this image and copyright information in PMC

References

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