Twin girls presented to the newborn nursery after delivery. The infants were born at 37\nweeks and 6 days gestation via spontaneous vaginal delivery to a 16-year-old gravida 1\nmother. Screening laboratory studies were negative, including group B streptococcus, human\nimmunodeficiency virus, hepatitis B, rapid plasma reagin, gonorrhea, and chlamydia.\nComplications during the pregnancy included gestational hypertension (diet controlled) and\ndichorionic diamniotic twin pregnancy. The mother had no significant medical history and\ndenied taking any medications during pregnancy. She also denied tobacco, alcohol, or illicit\ndrug use.\nDelivery was complicated by a breech vaginal delivery for twin B. Apgar scores were 7 at 1\nmin and 8 at 5 min, respectively, for twin A, and 7 at 1 min and 8 at 5 min, respectively,\nfor twin B.\n Birthweight was 2890 g (22nd percentile) for twin A and 2800 g (16th percentile) for\ntwin B. Neither twin sustained any trauma during delivery.\nPhysical examination in the newborn nursery revealed hypertrophic, erythematous and wet\nappearing mucosal sulci extending from the posterior vaginal fourchette to the anterior\nridge of the anus in both twins ( and ). Anus was\nnormally placed, centered in the sphincter, and patent with an anal wink present in both\ntwins. Urethral and vaginal openings were present and in appropriate locations on both\nexams. The remainder of the newborns’ exams were unremarkable. Written informed consent for\npatients’ images to be used for medical purposes was obtained from the mother of the\ntwins.\nConsultation was made to pediatric dermatology and obstetrics/gynecology who agreed with\nthe diagnosis and recommended no further intervention. The twin infants had benign neonatal\ncourses in the newborn nursery without development of complications. Screening tests\nincluding critical congenital heart disease and hearing screenings were passed for both\ntwins.\nThe twins were discharged home with primary care follow-up and a recommendation of referral\nto pediatric gynecology if the lesions did not epithelize by 2 years of age. No additional\nfollow-up data are available regarding the twins as they are followed for primary care at a\nhealth department in a different county.
This infant was born to Asian parents. The baby's mother was a 34-year-old woman, and her father was a 32-year-old man. The mother was gravida 2 and para 1 (G2P1) with good prenatal care. Their first baby was induced owing to intrauterine fetal death, and the details were unknown. There was no family history of congenital abnormalities on either side of the family, and the parents were not consanguineous. The mother also had no history of tobacco, alcohol, or substance abuse. The mother's antenatal examination was uneventful except for gestational diabetes. During pregnancy, the mother's blood glucose was maintained between 6.1 mmol/l and 8.1 mmol/l without any drug treatment. The infant's gestational age was 37 weeks and 3 days. The newborn was delivered by vaginal delivery and her birth weight (BW) was 4910 g. Apgar scores were 6 and 8 at 1 and 5 min, respectively. Owing to dyspnea 2 h after the birth, the neonate also received further examination in the NICU. On examination, a perineal defect was noted. The groove extended vertically downward from the base of the vaginal fourchette to the anterior rim of the anus at the 12 o'clock position. The perineal groove was a moist red sulcus that was ~1 cm long, 0.1 cm wide and 0.1 cm deep. There were no signs of malformation, bleeding, fistula, secretions, or infection noted in the genital area (Figure ). During admission, the infant had normal excretory functions. Her vital signs were as follows: temperature of 36.5°C; heart rate of 110 beats/min; respiratory rate of 65 breaths/min; and blood pressure of 75/39 mmHg. The newborn was diagnosed with asphyxia neonatorum, neonatal wet lung disease, fetal macrosomia, cephalohematoma of newborn, PDA, myocardial injury, and congenital perineal groove and as a neonate of a diabetic mother after further examinations. This diagnosis of perineal groove was also based on clinical examination. The neonate was discharged home with her parents at 9 days of life when all her conditions improved. Both patients in case one and case two were advised to undergo follow-up examinations.