Management of pregnancy in a patient with previous surgical repair of classic bladder exstrophy.

INTRODUCTION &

IMPORTANCE

Bladder exstrophy epispadias complex (BEEC) is a rare congenital midline malformation defect which requires complex, staged reconstruction of the bony pelvis and the genitourinary tract.

PRESENTATION OF CASE: A 26-year-old G3SA2 with previously reconstructed bladder exstrophy presented at 16 weeks +5 days gestation with severe bilateral hydronephrosis and inability to self-catheterize her Mitrofanoff diversion. She had bilateral nephrostomy tubes placed for the duration of pregnancy. Her pregnancy course was further complicated by recurrent pyelonephritis and progressive pelvic organ prolapse, culminating in cervical prolapse and concerns for uterine incarceration at 31 weeks. Given the complexity of her presentation, she was transferred from her rural community to a tertiary center and remained an inpatient throughout her third trimester.

CLINICAL DISCUSSION: Multidisciplinary planning involving obstetrics, maternal-fetal medicine, urology, and pediatrics led to the decision for an elective preterm caesarean section to minimize maternal morbidity. A healthy female infant was delivered without intraoperative complications.

CONCLUSION

Bladder exstrophy is a rare condition; however, advances in reconstructive surgery have enabled female patients to achieve longer life expectancies and consider pregnancy during their reproductive years. Such pregnancies are associated with specific antenatal and intraoperative challenges, necessitating a multidisciplinary team approach to ensure safe and timely delivery.