Vaginal Mass In a Neonate

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Image Source: The New England Journal of Medicine©

A protruding mass from the vagina of a newborn girl.

A baby girl was born via a spontaneous vaginal delivery at 36 weeks of gestation. On examination of the neonate, a soft mass was found protruding from her external genitalia.

There were no complaints about her urinary or bowel habits. She was passing urine and feces regularly.

During the examination when the baby cried, the protruding mass increased in size. However, there was no abdominal distension. The rest of the examination was normal. She was able to pass urine and feces regularly, and renal function was normal.

During the prenatal period, an ultrasound that was performed in the third trimester of pregnancy had identified a pelvic mass in the fetus; however, no further investigations were performed before delivery.

An abdominal ultrasound was performed on the neonate, and it confirmed hydrocolpos, with vaginal distention, a normal uterus, and no urinary tract dilatation.

On the third day of birth, a hymenal incision was performed under anesthesia, consequently resolving the mass.

After 2 months of the procedure, a follow-up ultrasound was performed. There was no residual mass, and the urinary tract and internal genitalia appeared normal.

Hydrocolpos is cystic dilation of the vagina with fluid accumulation due to the stimulation of secretory glands of the reproductive tract secondary to vaginal obstruction. It is imperative to detect early and treat as it can compress the lower urinary tract, which may lead to obstructive uropathy, consequently resulting in hydronephrosis and hydroureters.

Congenital hydrocolpos, as seen in this patient, is quite rare, with a prevalence of less than 1:30,000; on the other hand, it is more common at puberty.

If hydrocolpos is secondary to the imperforate hymen, then incision with drainage is performed; if vaginal atresia is the cause, then clean intermittent catheterization or vaginostomy can be performed.

Prompt management is desirable to avoid life-threatening renal failure and urogenital infections. The prognosis of imperforate hymen is excellent when treated, so the best approach is to manage the neonates in time to avoid any complications.

References

Marine Butin, M. P. (2019, December 12). Neonatal Hydrocolpos. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1905619

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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