56. Obstetrical Outcomes in Women with Complex Anorectal Malformations: A Case Series

• Published in: Journal of pediatric & adolescent gynecology 2023-04, Vol.36 (2), p.196-197
• Main Authors: Bhuiyan, Julia R., Quint, Elisabeth H., Dendrinos, Melina L.
• Format: Article
• Language: English
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2023.01.144

Anorectal malformations (ARMs) include a range of conditions, including cloacal malformations, rectoperineal fistula, and imperforate anus with rectovestibular or rectovaginal fistula. Patients born with ARMs often have associated Mullerian and vertebral-anorectal-cardiac-tracheoesophageal-renal-limb anomalies, and clinical decisions during early childhood and adolescence may be critical for fertility and obstetrical outcomes. Because there remains limited literature on pregnancy outcomes within this population, we sought to describe obstetrical outcomes of patients with ARMs at our institution. This study was deemed exempt by the Institutional Review Board. Patients were identified using search terms for ARMs and pregnancy, and demographic and clinical information was abstracted. Information regarding anorectal malformation characteristics and related procedures is presented in Table 1. Five patients were identified. Cloacal malformation was present in 3 patients, and imperforate anus with rectovaginal fistula was present in 2 patients. No patients had undergone creation of a bowel neovagina. Information regarding obstetrical outcomes is presented in Table 2. Ten pregnancies were reported in 5 patients. Two of the patients had term deliveries, and 2 had preterm deliveries. Cesarean section was the mode of delivery in all reported cases except for one patient who had 3 vaginal deliveries preceding her cesarean section. In total, 8/10 pregnancies resulted in delivery of a viable neonate. There were no reported delivery complications. One patient had two therapeutic abortions (tAb). Her second pregnancy was conceived by in vitro fertilization but complicated by maternal tracheoesophageal fistula and recurrent aspiration pneumonia with acute respiratory distress syndrome (ARDS) unresponsive to medical management; tAb was performed for maternal health. While the optimal management of anorectal malformations remains complex, the cases here demonstrate that reconstructive surgery can contribute to successful pregnancy and delivery. However, the patient with tracheoesophageal fistula who developed ARDS illustrates how the associated anomalies can lead to complications during pregnancy. It remains very rare for pregnancy to occur in patients with ARM and vaginal interposition with bowel. Further research is needed, likely involving prospective data collection from multiple institutions given the rarity and complexity of these conditions. Supporting Figures or Tabl