Antenatal diagnosis and successful management of fetal mucocolpometra in a resource-limited setting: a case report from Ethiopia

INTRODUCTION: Imperforate hymen is the most common congenital anomaly of the female genital tract, usually diagnosed at puberty. Neonatal presentation is rare, and antenatal diagnosis is even less common but increasingly recognized with advances in prenatal ultrasonography. Fetal mucocolpometra results from distal vaginal obstruction and may present as a cystic pelvic mass, with potential for postnatal complications such as urinary obstruction. CASE PRESENTATION: We report a 17-year-old primigravida from rural North-western Ethiopia whose fetus was found on late antenatal ultrasound to have a large cystic pelvic mass suggestive of mucocolpometra. At 37 weeks and 6 days of gestation, she underwent emergency cesarean section for obstetric indications. A live female neonate was delivered with good APGAR scores but developed marked abdominal distension and acute urinary retention shortly after birth. Examination revealed a bulging, bluish vaginal introitus. The diagnosis of mucocolpometra secondary to imperforate hymen was made. Hymenectomy was performed under sterile conditions, draining approximately 300 mL of milky fluid, with immediate clinical improvement. DISCUSSION: Antenatal detection of mucocolpometra remains uncommon, particularly in resource-limited settings. Early recognition is important to prevent complications such as urinary obstruction and abdominal distension. This case demonstrates that antenatal ultrasound alone can provide sufficient diagnostic suspicion to guide timely intervention, even where advanced imaging is unavailable. CONCLUSION: Fetal mucocolpometra should be considered in cases of antenatally detected pelvic cystic masses. Early diagnosis and prompt surgical management can result in excellent outcomes, even in resource-limited settings.