# Sirenomelia or mermaid syndrome with a cleft lip in a Tanzanian newborn: a case report

## TL;DR

A rare case of sirenomelia, or mermaid syndrome, with a cleft lip is reported in a Tanzanian newborn, highlighting the importance of prenatal care.

## Contribution

This case report adds to the limited literature on sirenomelia in African populations and emphasizes the role of early prenatal care.

## Key findings

- The newborn exhibited sirenomelia with fusion of lower extremities, ambiguous genitalia, and a cleft lip.
- Lack of prenatal screening and early ultrasound may have contributed to the poor outcome.
- Cultural and infrastructural barriers limited further diagnostic and post-mortem investigations.

## Abstract

Sirenomelia or sirenomelia sequence, also known as mermaid syndrome, is a rare congenital anomaly involving the caudal region of the body. The syndrome is characterized by partial or complete fusion of lower extremities, renal agenesis, absent urinary tract, ambiguous external genitalia, imperforate anus, and single umbilical artery. Sirenomelia is often associated with several visceral congenital malformations, rendering it invariably incompatible with extrauterine life.

We present the case of 22-year-old Black African woman who delivered a term newborn by caesarean section at a gestation age of 37 weeks due to obstructed labor with fetal distress. The newborn was a fresh stillbirth weighing 2100 g and had fusion of the lower extremities, a single upper limb, ambiguous genitalia, imperforate anus, and a cleft lip. The mother had made only two prenatal visits, at which she was found to be normotensive and normoglycemic. She was not screened for routine fetomaternal infections and missed supplementation for folic acid during the critical first trimester. She did not undergo any obstetric ultrasonography. The parents of the newborn were not close relatives and there was no family history of consanguinity. Further genetic testing was not performed due to lack of laboratory capacity, and post mortem examination was not permitted due to cultural taboo and restrictions relating to handling of deceased newborns.

Sirenomelia is a rare congenital malformation with very poor prognosis. Specific interventions during pre-conception and early prenatal care are critical in the prevention of specific congenital anomalies. Early obstetric ultrasonography is invaluable for diagnosis of sirenomelia as well as counseling for possible termination of pregnancy.