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.
A full-term female newborn with a birth weight (BW) of 3440 g was born at 39 weeks of gestation via cesarean section (CS) for breech presentation from a 37-year-old mother Gravida 3 Para 3 (G3P3); Apgar score was 6 and 10 at 1st and 5th minute of life, respectively. Baby was apneic at birth and received five inflation breaths, followed by good response with vigorous crying, good muscle tone and heart rate. The pregnancy was uneventful apart from a single echogenic intracardiac focus that was detected on the second trimester anatomy scan and was confirmed, both by fetal echocardiography (ECHO) at 22+6 weeks and a post-natal follow-up ECHO at 40 days of life, with no other abnormal findings. On the first physical examination, a midline defect was noticed on the newborn’s perineum, which formed an erythematous sulcus resembling a rupture that expanded about 1 cm from the posterior vaginal fourchette to the 12 o’clock position of the anterior anal opening. Both external genitalia and the anal orifice were intact and normally positioned. No active blood or passage of meconium via the vaginal opening was observed. The obstetrician placed four absorbable sutures in the malformed perineum, as he thought the defect represented tear of the area, and the newborn was transferred to the neonatal unit for prompt pediatric surgical evaluation. Frequent and meticulous hygiene of the affected area was maintained and a course of intravenous antibiotics was administered. The newborn remained stable throughout hospitalization with no evidence of infection. Parents refused to attend follow-up outpatient clinic (neonatal and pediatric consultation), and therefore we followed-up the case by frequent phone interviews; according to information provided by them, the infant had a full cicatrization of the perineal defect, with no defecation issues or local infection incidences.