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2012-09-04-08 Hydrocolpos ©Fabrice Cuillier www.TheFetus.net 



Two antenatal diagnosis of hydrocolpos and hydrometrocolpos. 

 

Fabrice Cuillier, MD., Kaufmann E., MD, Mardamootoo D.,Midwife, Blanc S., MD.
  Department of Gynecology, Hôpital Félix Guyon, 97400 Saint-Denis, Reunion, France 
 
 

Definition:  
Imperforate hymen is usually detected in the neonatal period or later, when the child presents the physical signs of lower abdominal cysts, and a bulging membrane at the introitus. 
Nethertheless, imperforate hymen can be suspected during antenatal period, when we discover an isolated hydrocolpos. 
We described two cases of hydrocolpos, discovering during the third trimester.  

Case report 1:  
Mrs. M., 36 years  old, has one healthy girl and no consanguinity with her husband. Family history was unremarkable.
The first and second ultrasound were normal (normal nuchal translucency, 1.7 mm / 60 mm ; Normal triple test, 1/2000). The fetal gender is female.  
But at 34 weeks, the third scan showed an abnormal structure near the bladder (Figure 1-3) which is covered by two umbilical arteries (Figure 4, 5). The suspected diagnosis was an ovarian cyst, hydrocolpos or mesenteric cyst. An MRI was planned, but the patient delivered the next day. 
The diagnosis of hydrometro-colpos was, in fact, confirmed by a postnatal sonography. Indeed, imperforate congenital hymen with mild hydrometro-colpos was present (Figure 6, 7). The kidney were normal. A drainage was performed sucessfully (hymenectomy). Six month later, the baby is well.   

Figure 1-3:
An abnormal structure near the bladder .



Figure 4, 5: The bladder between two umbilical arteries. 


 
Figure 6, 7: Postnatal ultrasound showed the  mild hydrometro-colpos after drainage. 


Case report 2:  

A 24-year-old primigravidaria was referred to our antenatal unit at 37 weeks for further evaluation of a fetal pelvic mass. Ultrasound examination performed at 12 weeks (nuchal translucency = 1 mm, Triple test = 1/1200) was normal. At 24  weeks , the fetal sonography revealed no abnormality.

At 35  weeks , the last ultrasound scan revealed appropriate-for-gestational age growth index, except for an abdominal mass. The mass was approximately 40 mm X 40 mm X 38 mm in diameter. The cyst appeared well-demarcated and hyperechoic in the center. 

At 37  weeks , the mass was located in the right inferior quadrant of the abdomen, near the bladder. The sex was female. At 39 weeks , the cyst measured 60 mm x 70 mm. Kidney were normal, except a moderate right renal pelvis dilatation (Figure 6). 
The couple was referred to genetic counseling to discuss additional testing options. Amniocentesis was not performed. The diagnosis was right ovary cyst, hydrocolpos or hydrometrocolpos. MRI confirmed the diagnosis of hydrocolpos (Figure 7-14).
The patient delivered spontaneously at 40 weeks , with a normal postnatal adaptation. At day 2, a postnatal sonography confirmed the diagnosis. Surgery was necessary with hymenectomy. The uterus and ovary were normal. The patient and her baby were discharged later.  
 
Figure 1, 2: At 37 weeks, the abnormal cyst appeared well-demarcated and hyperechoic in the center.



Figure 3-6: At 39 weeks, the cyst increased in size.




Figure 7-14: MRI on transverse and vertical plane.







 

 

 









 

 

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