VACTERL association after infertility treatment - case report

Abstract

VACTERL association includes at least three of the following congenital anomalies: vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal and limb abnormalities. The objective of article is to demonstrate the perinatal outcome of VACTERL case in 38-year-old pregnant woman with a history of infertility. Pregnancy has occurred after intracytoplasmic sperm injection and embryoscopy before embryo transfer. The 1st trimester ultrasound demonstrated right forearm anomaly-aplasia of the right radius and thumb. The normal female karyotype (46XX) was obtained. Increasing amniotic fluid index and invisible stomach from 26 weeks confirmed the suspicion of VACTERL association. After reduction of 900 ml of amniotic fluids at 34⁺⁴ weeks of gestation the symptoms of premature separation of placenta occurred. The newborn weight was 2,360 g according to Apgar scale assessment 5/5 at 1^st and 5^th minutes. Multiple reconstructive operations were performed after birth. Among them sigmostomy, gastrostomy, ezofageotraheal fistulae plastic, that were followed by bronchoscopy and fibrogastroscopy. VACTERL association is a sporadic phenomenon, but among ICSI pregnancies fetal structural abnormalities occurrence is slightly higher. Our case demonstrates that the different components included into VACTERL association can be visualized at different gestational age, allowing to suspecting this association later in the pregnancy and often not prior to delivery. The family must has to understand the consequences of complications and their impact on the quality of child life.