Optimizing cesarean delivery in a patient with exstrophy-epispadias via prenatal MRI and surgical planning: A case report

Abstract

Due to advancements in medical care and reconstructive surgery, more patients with bladder exstrophy are reaching reproductive age and considering pregnancy. Complications are more common during pregnancy in this patient population, given medical comorbidities and prior surgical intervention. In the case of cesarean delivery, careful planning is necessary to prevent inadvertent injury to the bladder or bowel segments. This report concerns a patient with a history of infant closure of bladder exstrophy, followed by two bladder augmentations and a catheterizable channel who presented for care at 9 weeks of gestation. Magnetic resonance imaging (MRI) at 36 weeks of gestation was used to delineate the anatomy in planning for cesarean delivery. The patient underwent a successful cesarean delivery at 38 weeks 1 day of gestation. Patients with prior urologic reconstruction can undergo safe cesarean delivery if proper surgical planning is performed. Multidisciplinary care and prenatal MRI are valuable tools for avoiding surgical complications.