Altaf Hussain Rathore ( Department of Surgery,Unit II, Quaid-e-Azam Medical College, Bahawalpur. )
Khalid Hayat Bhatti ( Department of Surgery,Unit II, Quaid-e-Azam Medical College, Bahawalpur. )
A case of a neonate with spina bif Ida who had prolapse of the uterus is presented The causes of genital prolapse in the new born and its treatment are reviewed. (JPMA 37 3 16, 1987).
A three days old full term female weighing 2.5 Kgs presented with a mass protruding through the vulva (Figure 1).
The baby also had a large meningomyelocoele in the lower lumber region, was paraplegic and incontinent of stool and urine. The mother was 5th Para, 28 years of age, had an uneventful pregnancy and delivered child was fairly active spontaneously at home.
The and her res piratory and cardiovascular system were normal. The abdomen was soft and has no palpable mass. The mass protruding through the vulva was a completely prolapsed uterus of normal size (Figure 1) which could be reduced digitally. The length of cervix was normal.
There was no movement or sensation in the lower limbs which were held in extension at the knee joints and 900 Flexion at the hips. Mild talipes equino varus was present bilaterally. The anal sphincters lacked tone.
The meningomyelo coele ruptured spontaneously during examination. X-Ray of the spine revealed gross spina bifida at the level of L4, L-5 along with kyphosis (Figure 2).
Blood examination revealed a Haemoglobin of 10.2 Gram, blood urea was 25 mg % and a serum biirubin 2.5 mg%
The meningo myelocoele was excised and repaired under local anaesthesia. The posterior half of the labia minora and major were partially fused, using two interrupted silk sutures after repositioning the prolapsed uterus as advised by Ajabor. The bady was given injection Gentainycin (10 nig per Kg body weight) before and for 7 days after operation. No intravenous infusion was required as the patient was feeding well. She made an uneventful recovery from the operation and there was no uterine prolapse even on straining (Figure 3).
She was discharged on the fourteenth day after operation. There was no sign of hydrocephalus, the neurological signs remained unchanged.
Uterine prolapse is a disease of multiparous women and is extremely rare in the new born as is suggested by paucity of case reports in the literature2-4
Findley4 attributes prolapse of uterus in spina bifida to a faulty innervation of the pelvic floor muscles resulting in their atrophy. There is also hypoplasia of the fat, connective tissue and ligaments of the pelvis.
Ajabar and Okojie1 have attributed genital prolapse in neonates to an enlarged cervix. This was not the case in our patient.
Fraser5 and Cotton and Williams6 found digital repositioning of the prolapsed uterus extremely satisfactory and found no further need for an additional procedure to keep the uterus reduced in our case simple digital reduction was unsuccessful as the prolapse recurred with the slightest straining.
Fusion of the posterior halves of tile labia was successful in preventing recurrence ol the prolapse.
1. Ajabor, L.N., and Okojie, S.E. Genital Prolapse in the newborn. International Surgery 1976; 61: 494.
2. Noys, I.H. Uterine prolapse associated with spina bifida in the new born, with report of a case. Amr. j. Obst. Gynecol., 1927; 13: 209.
3. Torpin, R. Prolapse uteri associated with spina bifida and club feet in newborn infants. Amer. J. Obst. Gynecol., 1942; 43: 892-894.
4. Findly, P. Prolapse of the uterus in nulliparous women. Amer. J. Obst. Dis. Worn., 1917; 75: 12.
5. Fraser, R.D. A case of gential prolapse in a newborn bady. Brit. Med. J., 1961; 5234:1011.
6. Cotton, D. Williams, E. Procidentia in the newborn. Obst., Gynec. Brit. Commwlth., 1975; 72:131.