JScholar Publishers Successful Pregnancy Outcome and Surgical Approach in Women with Re- paired Bladder Exstrophy or Cloacal Exstrophy – Experience from a quater- nary paediatric and adolescent gynaecology centre in Australia

Background: Women with repaired bladder/cloacal exstrophy face unique challenges throughout their pregnancy. Limited obstetric care information available in the current literature. Aims: To review perinatal issues, pregnancy outcomes and surgical techniques for five pregnancies in three women with repaired bladder exstrophy and cloacal exstrophy. Materials and Method Design: A case series and review of the literature. Setting: A quaternary obstetric and paediatric and adolescent gynaecology service in Queensland, Australia. Participants: Women with repaired bladder exstrophy and cloacal exstrophy, managed by the service over a ten-year period from January 2004 to January 2014. Main Outcome Measures: Identification of perinatal and surgical complexities for this cohort of women. Results Antenatal issues in these women with repaired bladder exstrophy or cloacal exstrophy include miscarriage (3/3), malpresentation (3/3), urological complications such as recurrent urinary tract infection (UTI) (3/3), pyelonephritis (1/3), urosepsis (1/3), renal calculi and hydronephrosis (1/3) and stress incontinence (1/3). Other issues identified were hypertension, uterine prolapse, threatened preterm labour, cervical insufficiency, and low lying placenta with antepartum haemorrhage. Surgical planning and foresight of anticipated difficulties at delivery in women with repaired bladder exstrophy and cloacal exstrophy is critical. Conclusions A Women with repaired bladder exstrophy and cloacal exstrophy present additional challenges for those caring for them in the perinatal period. Surgical approach to delivery is best achieved through elective caesarean section with a high midline skin incision to avoid damage to the reconstructed bladder, which overlies the usual transverse suprapubic skin incision made for a lower segment caesarean section.