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

Colette M Gnade,Joseph T Kowalski,Heather R Williams,Heather Anaya,Janet I Andrews

doi:10.17077/2154-4751.1372

Abstract

Exstrophy-epispadias sequence is an uncommon diagnosis in which surgical reconstruction has increased quality of life for these patients. As they are entering the reproductive phase of their life, consideration must be made for management of their pregnancies in the context of their genitourinary reconstruction. There have been few case reports of patients with cloacal exstrophy conceiving; therefore, information to guide management of their pregnancies is limited. Here we describe a patient with Omphalocele-Exstrophy-Imperforate Anus-Spinal defects (OEIS) and a patient with a history of bladder exstrophy both with spontaneous pregnancy managed by a multidisciplinary approach and primary cesarean delivery.

Highlights

Exstrophy-epispadias sequence (EES)encompasses a wide range of anterior wall defects including OmphaloceleExstrophy-Imperforate Anus-Spinal defects (OEIS) and bladder exstrophy
Due to the complex past surgical history and female anatomy following reconstruction, it is our recommendation that pregnant patients with EES be managed at a tertiary care center where a multidisciplinary team approach can be implemented to ensure the patient maintains her established quality of life and genitourinary function after delivery
Given that these patients have a spectrum of defects with co-morbidities, each patient will need individualized evaluation and delivery planning will depend on their surgical history and baseline genitourinary function in addition to the usual obstetric considerations

Summary

Introduction

Exstrophy-epispadias sequence (EES)encompasses a wide range of anterior wall defects including OEIS and bladder exstrophy. Both mother and infant were doing well at her 6 week postpartum visit and denied any incontinence or further UTIs. A Gravida 1 Para 0 26-year-old woman with a history of bladder exstrophy presented early in pregnancy for prenatal care.

Results

Conclusion