Multidisciplinary management of pregnancy in bladder exstrophy

BACKGROUND: Classic bladder exstrophy (CBE) is a rare congenital condition affecting multiple organs, primarily the urinary and musculoskeletal systems. Management involves multiple reconstructive surgical procedures and aims to maintain renal function, achieve urinary continence, and support normal reproductive health. Pregnancies in women with CBE can be complicated by recurrent urinary tract infections, pelvic prolapse, and a higher risk of preterm birth. CASE REPORT: We report the case of a 33-year-old woman with a history of CBE, admitted at 32 weeks of pregnancy with fever and symptoms of a urinary tract infection. Her medical history included multiple surgeries, including formation of neovesica from the cecum with appendicovesicostomy to the abdominal wall. The pregnancy was complicated by recurrent urinary tract infections, anemia, gestational diabetes, and stage IV uterine prolapse. A multidisciplinary team managed her care, with imaging revealing altered abdominal anatomy and breech fetal presentation. At 37 weeks, due to concerns about fetal growth restriction, breech position, and potential prolapse exacerbation, an elective cesarean delivery with median relaparotomy and vertical uterine fundal incision was performed to avoid emergency intervention. Both the delivery and postpartum recovery were uneventful despite the complexity of the case. CONCLUSIONS: Managing pregnancy in patients with CBE requires close, multidisciplinary collaboration to address potential complications. Detailed delivery planning and vigilant monitoring are crucial to ensure maternal and fetal safety.