Cloacal Exstrophy: An Epidemiologic Study From the International Clearinghouse for Birth Defects Surveillance and Research

Marcia L. Feldkamp*, Lorenzo D. Botto, Emmanuelle Amar, Marian K. Bakker, Eva Bermejo-Sanchez, Sebastiano Bianca, Mark A. Canfield, Eduardo E. Castilla, Maurizio Clementi, Melinda Csaky-Szunyogh, Emanuele Leoncini, Zhu Li, R. Brian Lowry, Pierpaolo Mastroiacovo, Paul Merlob, Margery Morgan, Osvaldo M. Mutchinick, Anke Rissmann, Annukka Ritvanen, Csaba SiffelJohn C. Carey

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

47 Citations (Scopus)

Abstract

Cloacal exstrophy presents as a complex abdominal wall defect thought to result from a mesodermal abnormality. Anatomically, its main components are Omphalocele, bladder Exstrophy and Imperforate anus. Other associated malformations include renal malformations and Spine defects (OEIS complex). Historically, the prevalence ranges from 1 in 200,000 to 400,000 births, with higher rates in females. Cloacal exstrophy is likely etiologically heterogeneous as suggested by its recurrence in families and occurrence in monozygotic twins. The defect has been described in infants with limb-body wall, with trisomy 18, and in one pregnancy exposed to Dilantin and diazepam. Due to its rarity, the use of a nonspecific diagnostic code for case identification, and lack of validation of the clinical findings, cloacal exstrophy remains an epidemiologic challenge. The purpose of this study was to describe the prevalence, associated anomalies and maternal characteristics among infants born with cloacal exstrophy. We used data from the International Clearinghouse for Birth Defects Surveillance and Research submitted from 18 birth defect surveillance programs representing 24 countries. Cases were clinically evaluated locally and reviewed centrally by two authors. Cases of persistent cloaca were excluded. A total of 186 cases of cloacal exstrophy were identified. Overall prevalence was 1 in 131,579 births: ranging from 1 in 44,444 births in Wales to 1 in 269,464 births in South America. Live birth prevalence was 1 in 184,195 births. Prevalence ratios did not vary by maternal age. Forty-two (22.6%) cases met the criteria for the OEIS complex, whereas 60 (32.3%) were classified as OEI and 18 (9.7%) as EIS (one with suspected VATER (0.5%)). Other findings included two cases with trisomy 13 (one without a karyotype confirmation), one with mosaic trisomy 12 (0.5%), one with mosaic 45, X (0.5%) and one classified as having amnion band sequence (0.5%). Twenty-seven (14.5%) infants had other anomalies unrelated to cloacal exstrophy. Cloacal exstrophy is a rare anomaly with variability in prevalence by geographic location. The proportion of cases classified as OEIS complex was lower in this study than previously reported. Among all cases, 54.8% were reported to have an omphalocele. (C) 2011 Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)333-343
Number of pages11
JournalAmerican Journal of Medical Genetics. Part C-Seminars in Medical Genetics
Volume157C
Issue number4
DOIs
Publication statusPublished - 15-Nov-2011

Keywords

  • cloacal exstrophy
  • prevalence
  • birth defects
  • clinical findings
  • OEIS complex
  • ANUS-SPINAL DEFECTS
  • VESICO-INTESTINAL FISSURE
  • NEURAL-TUBE DEFECTS
  • OEIS COMPLEX
  • EPISPADIAS COMPLEX
  • BLADDER EXSTROPHY
  • IMPERFORATE ANUS
  • COVERED EXSTROPHY
  • IDENTICAL-TWINS
  • CONJOINED TWINS

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