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.