胎儿异常膨出肿块-膀胱外翻1例报告

Joanna Łosińska, M. Respondek-Liberska
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引用次数: 1

摘要

摘要简介:产前诊断膀胱外翻极为罕见和困难。背景:由于泄殖腔膜发育异常,下腹壁不完全闭合,膀胱前壁缺失,后壁外露。耻骨通常分离,脐带插入低,外生殖器发育不正常。病例报告:39岁多孕多产妇,孕21周,由初级保健产科医生转介到高级专科中心进行详细的超声检查,怀疑膀胱缺失和下脐定位。妊娠29周时,在脐出口和阴唇之间发现2厘米的隆起肿块。妊娠31周时,先前检测到的大腿间结构直径为3cm,有外侧脐出口。大阴唇突出,小阴唇正常。在两条脐动脉之间有一个适当的腹腔内路线,没有与膀胱相应的跨声速区。新生儿足月出生,情况良好,但膀胱外露直径4厘米。尿道出口未见,女性生殖器异常。一个月后,女孩接受了原发性膀胱外翻闭合。虽然她反复患尿路感染,但总体情况良好。结论:产前诊断可及时发现并初步诊断严重畸形。早期诊断可以让父母为有缺陷的新生儿做好准备,并教他们如何照顾婴儿。
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Extraordinary Bulging Mass in the Foetus - A Case Report of Bladder Exstrophy
Abstract INTRODUCTION: Prenatal diagnosis of bladder exstrophy is extremley rare and difficult. BACKGROUND: Due to abnormal development of the cloacal membrane there is an incomplete closure of the lower abdominal wall, absence of the anterior wall of the bladder and external exposition of the posterior wall. The pubic bones are usually separated, the umbilical cord low inserted and there is abnormal external genitalia development. CASE REPORT: At 21st week of gestation of 39-year-old multigravida multipara referred by a primary care obstetrician to high-specialised centre for a detailed ultrasound examination with a suspicion of bladder absence and inferior umbilical localisation. At 29 weeks of gestation presence of bulging mass of 2 cm, between the umbilical outlet and labia was detected. At 31 weeks of gestation previously detected structure among thighs had 3 cm diameter with lateral umbilical outlet. Major labia were prominent and minor labia were within normal limits. Between two umbilical arteries with an appropriate intraabdominal course there were no transsonic area corresponding to the urinary bladder. The newborn baby was born at term in a good condition, but with an exposed bladder of 4 cm in diameter. The urethral outlet was not visualised and the female genitals were abnormal. After a month the girl underwent primary bladder exstrophy closure. Although she suffers from recurring urinary tract infections, she is in a good general condition. CONCLUSIONS: Due to prenatal diagnostics it was possible to detect and make an initial diagnosis of severe malformation. Early diagnosis allowed to prepare parents for a newborn with a defect and teach them how to take care of the baby.
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