THE PRENATAL-DIAGNOSIS OF CLOACAL EXSTROPHY

Purpose: We assess and clarify diagnostic features for making the pren atal diagnosis of cloacal exstrophy. Materials and Methods: We evaluat ed 9 patients born with cloacal exstrophy at our institutions (2 prosp ectively and 7 retrospectively) for diagnostic features on prenatal ul trasound studies. We also thoroughly reviewed the literature on 13 pre vious prenatally diagnosed cloacal exstrophy cases. Diagnostic criteri a were assessed by combining the findings in our patients and those in previous reports. Results: Of the 22 patients with prenatal ultrasoun d studies and cloacal exstrophy whom we analyzed 1 of our 9 and 2 in t he literature had a cloacal membrane that persisted at 22 weeks of ges tation. Major ultrasound criteria for diagnosing cloacal exstrophy pre natally are nonvisualization of the bladder, a large midline infraumbi lical anterior wall defect or cystic anterior wall structure (persiste nt cloacal membrane), omphalocele and lumbosacral anomalies. Seven les s frequent or minor criteria include lower extremity defects, renal an omalies, ascites, widened pubic arches, a narrow thorax, hydrocephalus and 1 umbilical artery. Conclusions: We propose major and minor crite ria to assist in the prenatal diagnosis of cloacal exstrophy. Despite these major and minor criteria the certainty of establishing a prenata l diagnosis remains challenging. Persistence of the cloacal membrane b eyond the first trimester in 1 patient was an exception to the classic concept of cloacal exstrophy embryogenesis. An accurate prenatal diag nosis requires validation of these criteria by further correlation of prenatal and postnatal observations.