Successful pregnancy and childbirth in a Zambian adolescent with unrepaired bladder exstrophy: a case report

Bladder exstrophy is a rare major congenital anomaly of the paediatric urogenital system, occurring in approximately 1 in 30,000 to 50,000 live births with a female-to-male ratio of approximately 1:2.3. Pregnancy in adolescent women with unrepaired bladder exstrophy is exceptionally uncommon and presents unique obstetric and urological challenges. To the best of our knowledge, neither adolescent pregnancy complicated by unrepaired bladder exstrophy nor untreated bladder exstrophy in pregnant or nonpregnant patients has previously been reported in Zambia. We report the case of a 14-year-old primigravida at 36 weeks and 5 days of gestation with unrepaired bladder exstrophy, referred from Zimba Mission Hospital to Livingstone University Teaching Hospital for specialised obstetric and urological management. Physical examination revealed classic bladder exstrophy, with absent lower anterior abdominal wall overlying the bladder, exposed bladder mucosa with visible bilateral ureteric orifices, absent urethra and external genital structures, and anterior displacement of the vaginal opening. Antepartum ultrasound scan confirmed a live intrauterine foetus in transverse lie with bilateral renal abnormalities while postpartum CT imaging demonstrated undeveloped pubic bones and extensive ureteric mural calcifications. Although elective caesarean section had been planned, the patient went into labour and successfully delivered a healthy male neonate weighing 3.5 kg via lower-segment caesarean section through breech extraction, with an Apgar score of 9/10 at 1 min. This case demonstrates that successful maternal and neonatal outcomes are possible in adolescent pregnancy complicated by unrepaired bladder exstrophy, despite considerable anatomical, obstetric, and social challenges. It further underscores the need for early diagnosis, multidisciplinary care, timely referral to specialised centres, and stronger social support systems for patients living with untreated congenital anomalies in resource-constrained settings.