Discussion
Fetal hematometrocolpos is usually an incidental finding during routine
antenatal ultrasound scans. There are no known risk factors, and the
diagnosis usually becomes more apparent at later stages of pregnancy,
with the increasing size of the lesion.
Most reports of fetal hematometrocolpos describe a pear-shaped cystic
mass with fluid-debris level in the fetal pelvis posterior to the
bladder and anterior to the rectum and most are diagnosed after 32 weeks
of gestation,3,4 however Winderl et al. reported a
case at 25 weeks of gestation which appears to be the earliest fetal
diagnosis in the literature.5
Due to the low incidence of fetal hematometrocolpos, the associated
ultrasound findings often prompt clinicians to request further imaging,
mostly fetal MR scans to clarify the diagnosis and the extent of the
lesion.4 However, this is not always feasible,
particularly in low resource healthcare settings or at advanced
gestational age. On the other hand, timely diagnosis, preferably before
delivery, provides great advantage to the paediatrician to arrange for
appropriate postnatal surgical management of the neonate in a paediatric
surgical centre with relevant experience.
While hematometrocolpos in the neonate is not life threatening per se,
delayed diagnosis and intervention can lead to unnecessary
investigations and, depending on the size of the lesion, can cause
obstruction in the urinary tract or compromise perfusion of the lower
limbs due to the external pressure effect on surrounding tissues.
In our case, accurate ultrasound diagnosis allowed us to organize timely
surgical management, resulting in full resolution of the
hematometrocolpos with no reaccumulation at three months of age.
Importantly, from the imaging point of view, this case was managed
entirely aided by ultrasound scans, indicating that cross-sectional
imaging is not mandatory for successful management of these patients.
This is of great significance in low resource healthcare settings, where
access to fetal MR may not be readily available.