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Tennant PWG, Glinianaia SV, Wellesley D, Draper ES, Kurinczuk JJ, Tonks AM, Tucker DF, Wreyford B, Rankin J. Epidemiology of partial urorectal septum malformation sequence (or 'persistent cloaca'): a population-based study in seven regions of England and Wales, 1985-2010. Arch Dis Child Fetal Neonatal Ed 2014; 99:F413-8. [PMID: 25115921 DOI: 10.1136/archdischild-2014-306027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Partial urorectal septum malformation (pURSM) sequence (or 'persistent cloaca') is a rare congenital anomaly characterised by a joining of the urethral, anal, and genital openings into a single common channel. This study describes the epidemiology of pURSM sequence in England and Wales including prevalence, additional anomalies, and pregnancy outcomes. METHODS All cases of pURSM sequence prospectively notified to seven congenital anomaly registers in England and Wales during 1985-2010, whether delivered as live births, spontaneous fetal deaths (≥20 weeks' gestation), or elective terminations of pregnancy for fetal anomaly (TOPFA, any gestation), formed this population-based cohort. The risks of spontaneous fetal and infant death were examined by Kaplan-Meier analysis. Differences in prevalence over time, and between regions, were examined by multilevel Poisson regression. RESULTS 117 cases were recorded among 4,251,241 total births. Six (5%) pregnancies resulted in spontaneous fetal deaths, 53 (45%) in TOPFA, and 58 (50%) in live births. The prevalence was 2.8 (95% CI 2.3 to 3.4) per 100,000 total births, increasing significantly over time (p=0.002) and differing significantly between regions (p=0.005). 77 cases (66%) had at least one additional major congenital anomaly outside the perineum, including 67 (57%) renal, 29 (25%) musculoskeletal, 26 (23%) digestive system, and 24 (21%) cardiovascular anomalies. The risks of spontaneous fetal and infant death were estimated as 8.9% (95% CI 4.1 to 18.8) and 26.3% (95% CI 15.1 to 43.4) respectively. CONCLUSIONS This is the largest study of the epidemiology of pURSM sequence. The information will be valuable for families and health professionals whenever a case of pURSM sequence is diagnosed.
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Affiliation(s)
- Peter W G Tennant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Diana Wellesley
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Jenny J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ann M Tonks
- West Midlands Congenital Anomaly Register, Public Health England, Birmingham, UK
| | - David F Tucker
- Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, UK
| | - Ben Wreyford
- School of Clinical Sciences, Bristol University, Bristol, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK Regional Maternity Survey Office, Public Health England, Newcastle upon Tyne, UK
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Giant cystic meconium peritonitis associated with a cloacal anomaly: case report. J Pediatr Surg 2008; 43:E21-3. [PMID: 18358269 DOI: 10.1016/j.jpedsurg.2007.10.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 10/27/2007] [Accepted: 10/30/2007] [Indexed: 11/22/2022]
Abstract
This report describes a case of giant cystic meconium peritonitis (GCMP) associated with a cloacal anomaly. Antenatal ultrasonography and magnetic resonance imaging demonstrated persistent fetal ascites, bilateral hydronephrosis, and 3 pelvic cystic structures. The baby girl showed duplicated hydrocolpos and a single orifice of the cloaca with a long common channel inducing a urinary outflow obstruction. After constructing a diversion colostomy, a cutaneous vesicostomy was necessary to prevent recurrent urinary tract infections. These findings are consistent with a prenatal diagnosis of cloacal anomalies, thus suggesting an association with severe obstruction of lower urinary tract and meconium peritonitis. Most of reported cases of meconium peritonitis associated with the cloaca show fibroadhesive types with scattered intraperitoneal calcifications and adhesions. However, the present case showed a rare GCMP suggesting continuous urinary influx via the fallopian tubes until the later stage of intrauterine life.
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Subramanian S, Sharma R, Gamanagatti S, Agarwala S, Gupta P, Kumar S. Antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus. Pediatr Radiol 2006; 36:1086-9. [PMID: 16810498 DOI: 10.1007/s00247-006-0249-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 04/05/2006] [Accepted: 05/01/2006] [Indexed: 10/24/2022]
Abstract
Hydrometrocolpos is cystic dilatation of the vagina and uterus due to congenital vaginal obstruction. It may be secretory or urinary in character and manifests in the neonatal period with abdominal distension. Urinary hydrometrocolpos occurs in patients with urogenital sinus or cloacal anomaly. A rare case of antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus is presented.
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Affiliation(s)
- Subramanian Subramanian
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Yagel S, Imbar T, Valsky DV. Re: outcome of pregnancy in chromosomally normal fetuses with increased nuchal translucency in the first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:417-421. [PMID: 11952979 DOI: 10.1046/j.1469-0705.2002.00533_4.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Wheeler PG, Weaver DD. Partial urorectal septum malformation sequence: a report of 25 cases. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 103:99-105. [PMID: 11568914 DOI: 10.1002/ajmg.1510] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have identified 25 cases with what we are calling the partial urorectal septum malformation (URSM) sequence, which were seen in our institution over the past 27 years. The partial URSM sequence is defined as a single perineal/anal opening that drains a common cloaca in combination with an absent (imperforate) anus. In the 25 patients reported here, the partial URSM sequence was more common in females, with a female to male ratio of 18 to 7. Ambiguous genitalia were common in both sexes. Internal pelvic structures typically showed a cloaca with the bladder and rectum (and vagina in females) coalescing into a common canal that connected to the external surface in the perineal or anal area. Abnormalities of the internal genitalia were also common, with 12 females having a bifid or septate vagina and 11 having a bicornuate uterus. Renal anomalies were frequent in both sexes, with 10 of 25 patients having unilateral cystic renal dysplasia and 7 of 25 patients having unilateral renal agenesis. Twenty-one of 25 patients survived long term. By definition, the partial URSM sequence is a milder expression of the full URSM sequence, which is defined as having no perineal or anal openings and is typically associated with an internal cloaca. The URSM spectrum, which encompasses the partial and full URSM sequences, is believed to be caused by abnormalities of septation of the primitive cloaca. The URSM spectrum is distinct from the VATER association and conditions caused by sex hormone abnormalities, such as congenital adrenal hyperplasia.
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Affiliation(s)
- P G Wheeler
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.
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Fogata ML, Collins HB, Wagner CW, Angtuaco TL. Prenatal diagnosis of complicated abdominal wall defects. Curr Probl Diagn Radiol 1999; 28:101-28. [PMID: 10403093 DOI: 10.1016/s0363-0188(99)90007-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The accurate prenatal diagnosis of anterior abdominal wall defects is important because it affects patient management and prognosis. The pathophysiology of each defect leads to key characteristics that make it possible to differentiate one entity from another. Among these features are the location of the defect in relation to cord insertion, the size and contents of the defect, and the associated anomalies. This article reviews the underlying defects, the characteristic ultrasound findings, the associated anomalies, and the prognosis of simple and complicated abdominal wall defects. The basic features of simple abdominal wall defects (i.e., omphalocele and gastroschisis) were used as the initial points of assessment. A comparison of the different features of these abnormalities and how they differ from one another resulted in the development of criteria that facilitated the understanding of the different ultrasound manifestations of these anomalies.
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Affiliation(s)
- M L Fogata
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, USA
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Liang X, Ioffe OB, Sun CC. Cloacal dysgenesis sequence: observations in four patients including three fetuses of second trimester gestation. Pediatr Dev Pathol 1998; 1:281-8. [PMID: 10463289 DOI: 10.1007/s100249900040] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cloacal dysgenesis is a rare malformation sequence. We studied cloacal dysgenesis in four fetuses, including three at 18-22 weeks of gestation. All four fetuses showed a smooth perineum with absence of anal, urethral, and/or vaginal openings. The urinary bladder was dilated in 3 cases. The labia majora and minora were absent in the two female fetuses; the scrotum and penis were absent in one male fetus and hypoplastic in the second. The kidneys were either absent (1 case), dysplastic (1 case), or hydronephrotic (1 case). Normal kidneys were seen in a fetus of 20-22 weeks gestation in whom the urinary obstruction was alleviated by a vesicocolonic fistula. This fetus did not have pulmonary hypoplasia. Severe renal anomaly and pulmonary hypoplasia are the limiting factors for the survival of infants born with cloacal dysgenesis. The unique observation of normal kidneys and lungs in one of our fetuses, despite anhydramnios, suggests that the effect of oligohydramnios on lung development may be limited early in gestation, at least up to 20-22 weeks. It may also indirectly support the theory that there are factors other than oligohydramnios that interfere with early lung development, such as reduced production of a pulmonary growth factor by the kidney or reduced proline production by malformed kidneys, that may cause decreased collagen formation and result in hypoplastic lung mesenchyme.
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Affiliation(s)
- X Liang
- Department of Pathology, University of Maryland Hospital, Baltimore 21201, USA
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Pauli RM. Lower mesodermal defects: a common cause of fetal and early neonatal death. AMERICAN JOURNAL OF MEDICAL GENETICS 1994; 50:154-72. [PMID: 8010347 DOI: 10.1002/ajmg.1320500206] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Among the first 1,130 referrals to the Wisconsin Stillbirth Service Program 17 infants have been recognized to share phenotypic characteristics involving the genital, urinary, lower gastrointestinal, and axial skeletal systems. The pattern of abnormalities identified appears to be limited to structures sharing a common embryologic origin. These features, for the most part, are shown to be non-randomly associated. No clearly definable sub-groups within this population are demonstrable. The pattern of abnormalities is defined to include abnormalities of the following structures as pathogenetically primary features: lumbosacral vertebrae, kidneys, ureters, uterus/fallopian tubes, vagina, bladder, urethra, adrenals, gonads, anorectum, external genitalia, and umbilical arteries. An embryologic mechanism is proposed which explains this non-random association as arising secondary to disruption of structures derived from the lower portion of the primitive intraembryonic mesoderm. The Lower Mesodermal Defects Sequence appears to be a rather common (and under-recognized) cause of stillbirth and immediate neonatal death.
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Affiliation(s)
- R M Pauli
- Department of Pediatrics and Medical Genetics, University of Wisconsin-Madison
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Murr MM, Waziri MH, Schelper RL, Abu-Youself M. Case of multivertebral anomalies, cloacal dysgenesis, and other anomalies presenting prenatally as cystic kidneys. AMERICAN JOURNAL OF MEDICAL GENETICS 1992; 42:761-5. [PMID: 1554010 DOI: 10.1002/ajmg.1320420602] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a newborn boy on whom prenatal ultrasonography demonstrated intrauterine growth retardation, multiple vertebral anomalies, cystic kidneys, and oligohydramnios. Autopsy findings included multiple vertebral anomalies, cloacal dysgenesis (imperforate anus, vesicorectal fistula, and bilateral renal dysplasia), sacral absence, single umbilical artery, pulmonary hypoplasia, scoliosis, and hexadactyly of the left thumb. Although our case resembles a previously described case, a definitive diagnosis could not be made. The differential diagnosis included a variant of spondylocostal dysostosis and the VATER association.
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Affiliation(s)
- M M Murr
- Department of Surgery, University of Iowa Hospitals, Iowa City 52242
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Wright JR, Barth RF, Neff JC, Poe ET, Sucheston ME, Stempel LE. Gastrointestinal malformations associated with prune belly syndrome: three cases and a review of the literature. PEDIATRIC PATHOLOGY 1986; 5:421-48. [PMID: 3537997 DOI: 10.3109/15513818609068868] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Prune belly syndrome (PBS), a triad consisting of abdominal musculature hypoplasia, urinary tract malformations, and cryptorchidism, is frequently associated with other congenital malformations. Although it is acknowledged that gastrointestinal (GI) malrotation and mesenteric anomalies are frequent in PBS, other GI anomalies are generally considered to be exceedingly rare. Here we describe 3 autopsy cases with severe malformations of both midgut and hindgut derivatives and review the world literature to evaluate the spectrum of GI malformations associated with this syndrome. The relatively high frequency of distal stenoses and atresias suggests that the anomalous mesenteric attachments may predispose to prenatal volvulus and subsequent anatomic bowel obstruction. Postnatal volvulus is also occasionally observed. Infants with PBS also appear to be at a higher risk for persistence of the common fetal cloaca.
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Dajani AM. Persistent cloaca in adult with satisfactory renal function. Urology 1983; 22:51-5. [PMID: 6868250 DOI: 10.1016/0090-4295(83)90347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A case of persistent and uncorrected cloaca in a twenty-five-year-old woman is presented. In spite of the anomaly not being corrected, no deterioration of her kidney function was noted. She is continent for both urine and stools. In addition to two uteri which were removed at different times, she has only one kidney on the right which is ectopic and malrotated, and an abnormal left thumb. The question of doing electromyographic studies of the pelvic muscles prior to the repair of the anomaly, together with the timing of the latter, is raised.
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Frenkel Y, Atlas M, Horowitz A, Mashiach S. Fetal common cloaca--a case report and review. Eur J Obstet Gynecol Reprod Biol 1980; 11:115-20. [PMID: 7192656 DOI: 10.1016/0028-2243(80)90017-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A case is presented in which a huge cystic mass adjacent to the outline of a 29-wk fetus was identified by ultrasonography. After delivery this was proven to be a common cloaca in a fetus with multiple congenital anomalies. The possible mechanisms of this anomaly are discussed.
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