Successful vaginal delivery in a patient with reconstructed bladder exstrophy and vaginoplasty after cesarean section, a case report from Syria.

Abstract

Introduction and importance: Bladder exstrophy (BE) is a rare congenital anomaly in which the anterior wall of the bladder is absent. In females, sexuality and fertility may be negatively affected with the association with pubic diastasis, dysplasia of the pelvic floor muscles, clitoris bifurcated, short vagina or narrow introitus.

Presentation of case: We present a case of 26-year-old woman with treated BE, vaginoplasty, and bicornuate uterus that came at week 36 of gestation. An elective cesarean section was made by paramedian section. Five years later, she came back with placental abruption at week 30 of gestation, and a successful vaginal delivery was made.

Discussion: Bladder exstrophy is a challenging disease that is accompanied with other morbidities. Impaired fertility is common due to previous surgeries and concomitant diseases, and pregnancy is high risk for both mother and baby. Delivery should be at a tertiary referral obstetric hospital.

Conclusion: Balancing the pros and cones of medical decision in order to achieve the best outcomes for both the mother and child is crucial, as choosing the right decision depends on the presentation and past history of the patient not only the existence of the bladder exstrophy.