Abstract Background: Anorectal malformations (ARM) represent a wide spectrum of congenital anomalies in which the anus fails to open normally onto the perineum. In females, the most common ARM is an imperforate anus with a rectovestibular fistula. There are limited data available on the optimal management of an uncorrected rectovestibular fistula in pregnancy. Case: A 23-year-old gravida 3, para 2, living, 1, with a history of fecal incontinence since birth and of passing stools through the orifice near the vestibular region, was admitted at 34+3 weeks' gestation for evaluation of ARM. On examination, a prominent skin tag was present at the anal dimple with normal gluteal fold and a fistulous opening in the region of vestibule with minimal prolapse of rectal mucosa. The patient underwent an elective cesarean section with sterilization at 38+3 weeks' gestation in view of having had two previous cesarean sections. Results: Her postnatal period was uneventful and she was discharged on the 7th postoperative d...