The prenatal diagnosis of cloacal dysgenesis sequence in six cases: can the termination of pregnancy always be the first choice?
OBJECTIVE
Cloacal dysgenesis sequence is a lethal malformation, which usually requires termination. In this study, our aim was to evaluate the prenatal and postnatal diagnostic features of cloacal dysgenesis sequence and review the management of the patients.


METHODS
The data of six cases of cloacal dysgenesis sequences were collected from the ultrasonography and neonatal records. The findings were evaluated in prenatal and postnatal periods. Chromosomal analysis was performed in all the cases. The evaluation of primary and secondary malformations was done. Coexisting anomalies were searched for by radiology and histopathology.


RESULTS
Malformations in six cases (two females and four males) were described. The absence of anal, genital, and urinary openings with intact perineum covered by smooth skin were common findings. These features were considered as primary malformations for cloacal dysgenesis sequence. Secondary anomalies (urinary and gastrointestinal system malformations, pulmonary hypoplasia, and other coexisting anomalies) were evaluated.


CONCLUSIONS
The prenatal differential diagnosis of cloacal dysgenesis sequence from other urinary obstructive diseases was essential regarding fetal prognosis, prenatal, and neonatal management. The bladder outlet obstruction and pulmonary hypoplasia due to reduced amniotic fluid and/or kidney disease were considered prognostic factors for neonatal death. Termination of pregnancy is almost always recommended instead of intrauterine shunt procedures; but if we take into consideration one of our cases and a few reported cases who survived in the neonatal period, the prenatal management of these pregnancies needs to be reevaluated.
Sahinoglu
Zeki
Z
Division of Perinatology, Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education und Research Hospital, Uskudar, Istanbul, Turkey. zekisa@ixir.com
Mulayim
Baris
B
Ozden
Selcuk
S
Etker
Seref
S
Celayir
Aysenur
A
Ozkan
Ferda
F
Bilgic
Remziye
R
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology; D000028:Abortion, Induced; D000328:Adult; D002988:Cloaca / Q000002:abnormalities* / Q000196:embryology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D014421:Turkey; D016216:Ultrasonography, Prenatal; D014570:Urologic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology