Article Text

Download PDFPDF
Epidemiology of partial urorectal septum malformation sequence (or ‘persistent cloaca’): a population-based study in seven regions of England and Wales, 1985–2010
  1. Peter W G Tennant1,
  2. Svetlana V Glinianaia1,
  3. Diana Wellesley2,
  4. Elizabeth S Draper3,
  5. Jenny J Kurinczuk4,
  6. Ann M Tonks5,
  7. David F Tucker6,
  8. Ben Wreyford7,
  9. Judith Rankin1,8
  1. 1Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
  2. 2Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
  3. 3Department of Health Sciences, University of Leicester, Leicester, UK
  4. 4National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  5. 5West Midlands Congenital Anomaly Register, Public Health England, Birmingham, UK
  6. 6Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, UK
  7. 7School of Clinical Sciences, Bristol University, Bristol, UK
  8. 8Regional Maternity Survey Office, Public Health England, Newcastle upon Tyne, UK
  1. Correspondence to Peter W G Tennant, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK; peter.tennant{at}


Background Partial urorectal septum malformation (pURSM) sequence (or ‘persistent cloaca’) is a rare congenital anomaly characterised by a joining of the urethral, anal, and genital openings into a single common channel. This study describes the epidemiology of pURSM sequence in England and Wales including prevalence, additional anomalies, and pregnancy outcomes.

Methods All cases of pURSM sequence prospectively notified to seven congenital anomaly registers in England and Wales during 1985–2010, whether delivered as live births, spontaneous fetal deaths (≥20 weeks’ gestation), or elective terminations of pregnancy for fetal anomaly (TOPFA, any gestation), formed this population-based cohort. The risks of spontaneous fetal and infant death were examined by Kaplan–Meier analysis. Differences in prevalence over time, and between regions, were examined by multilevel Poisson regression.

Results 117 cases were recorded among 4 251 241 total births. Six (5%) pregnancies resulted in spontaneous fetal deaths, 53 (45%) in TOPFA, and 58 (50%) in live births. The prevalence was 2.8 (95% CI 2.3 to 3.4) per 100 000 total births, increasing significantly over time (p=0.002) and differing significantly between regions (p=0.005). 77 cases (66%) had at least one additional major congenital anomaly outside the perineum, including 67 (57%) renal, 29 (25%) musculoskeletal, 26 (23%) digestive system, and 24 (21%) cardiovascular anomalies. The risks of spontaneous fetal and infant death were estimated as 8.9% (95% CI 4.1 to 18.8) and 26.3% (95% CI 15.1 to 43.4) respectively.

Conclusions This is the largest study of the epidemiology of pURSM sequence. The information will be valuable for families and health professionals whenever a case of pURSM sequence is diagnosed.

  • Epidemiology
  • Congenital Abnorm

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.