Case Report: Recurrent Placental Abruption During Pregnancy in a Patient With Pseudoexstrophy

Abstract

Background: Pseudoexstrophy is a rare variant of the exstrophy-epispadias complex, which comprises musculoskeletal defects associated with bladder exstrophy without any urinary tract defects. However, only a few pregnancy complications have been reported in patients with pseudoexstrophy.Case Presentation: This report presents the case of a woman with pseudoexstrophy, who survived recurrent placental abruption during the second trimester of her pregnancy. The patient presented with a bicornuate uterus and survived placental abruption twice, which may have resulted from the malformation of the uterus. Placental abruption occurred at 20 weeks during her first pregnancy, and because she was already in labor, uterine contraction was augmented until vaginal delivery was achieved. The second pregnancy, however, could not be terminated quickly enough; therefore, a cesarean section was performed to save the patient's life.Conclusions: Our study makes a significant contribution to the literature although pregnancy complications have been reported in patients with pseudoexstrophy. Our findings show that in female patients with pseudoexstrophy who are or wish to become pregnant, detailed imaging studies must be performed to identify any deformities of the pelvis or reproductive organs, in order to make a pregnancy-related risk assessment. Our experience also indicates that if surgery is inevitable, the obstetrician must be more careful when entering the abdominal cavity during the surgery to avoid secondary injury. Furthermore, the peritoneum and fascia layers must be sutured more firmly when closing the abdomen to avoid an abdominal wall hernia, because of the lack of abdominal muscle and fat tissue in such patients.