Newborn Female With a Perineal Abnormality

Abstract

A term female newborn infant was delivered to a 39-year-old, gravida 3, para 3 mother by spontaneous vaginal delivery. Both parents were of Hispanic descent. The family history was unremarkable for congenital anomalies. The mother’s antenatal history was without concerns except for advanced maternal age. There was no maternal history of smoking or alcohol or substance abuse during the pregnancy. The pregnancy was complicated by gestational diabetes controlled with diet and echogenic bowel found on 16-week prenatal ultrasonography. The mother declined any follow-up ultrasonography or genetic testing. All maternal serologic test results were negative except group B streptococcal perineal culture. Because of group B streptococcal positivity, the mother received 3 doses of ampicillin before an uncomplicated, vaginal delivery. The infant’s Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. At birth the infant was appropriate for gestational age with regard to weight (3,314 g), length (47 cm), and head circumference (34 cm). On physical examination, she was noted to have an abnormal tissue projection from her vaginal orifice (Figure). On inspection of the child’s vaginal opening, a pedunculated mass was appreciated to be extending from the vagina. The lesion measured 30 mm long, 1 to 2 mm wide proximally, and 4 mm wide at the distal ovoid segment. Careful visual inspection of the genital area with lighted magnification tracked the lesion to an origin within the vagina. The lesion originated from an area …