**3.7. Omphalocele-exstrophy of bladder-imperforate anus-spinal deformities complex (OIES complex)**

OIES complex represents the most severe expression of the abnormal development of the cloaca with the arrest of the urorectal septum in the 7th–8th week of gestation. The reported incidence is rare, of only 0.025–0.04 in 10,000 live births [100, 101]. The diagnosis is accessible early in pregnancy, at the end of the first trimester. The imagistic findings include the presence of omphalocele and bladder exstrophy, associated with anomalies of the spine. The imperforated anus is often found postnatally, even if it can be detected antenatally, but with high suspicion by specialized observer. Other anomalies evaluated with OIES complex are spina bifida, genital anomalies, fistulas, renal anomalies, limb hypoplasia, craniofacial anomalies and single umbilical artery [86]. As the prognosis is poor when multiple structural defects are associated, termination of pregnancy is offered as an option to the couple, after multidisciplinary prenatal counseling. If desire to continue the pregnancy, there is a high risk of preterm delivery, low birth weight or intrauterine death. The proper treatment of OIES complex includes a series of surgeries depending on the severity of the condition [100, 101].
