Torsion of the pregnant uterus

A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.

Sinéquia intra-uterina: importância e tratamento / Intrauterine adhesions: importancy and treatment

Os autores fazem uma revisão e atualização sobre as sinéquias intra-uterinas (SIUs), enfocando principalmente sua importância atual e o método histeroscópico para o tratamento dessa afecção. Outros enfoques terapêuticos como a histerotomia no tratamento das SIUs totais, limitações do método histeroscópico e eventuais complicações obstétricas subseqüentes à sinequiolise histeroscópica são também discutidos neste trabalho

Estudo comparativo entre indicaçöes cirúrgicas e diagnóstico anatomopatológico de histerectomias no Hospital de Clínicas de Porto Alegre (HCPA) / A comparative study of surgical indications and pathological diagnosis of the hysterectomies performed at the Hospital de Clinicas de Porto Alegre (HCPA)

A histerectomia é uma das cirurgias ginecológicas mais frequentes. Assim, torna-se importante determinar suas indicaçöes clínicas e tipo de cirurgia e correlacioná-los com a confirmaçäo anatomopatológica. Foram revisados 738 prontuários das pacientes histerectomizadas no HCPA. A correlaçäo clínico-patológica mostrou que as patologias mais prevalentes säo o mioma uterino (395), a adenomiose (174), a hiperplasia endometrial (88) e o carcinoma de endométrio (69) com p>0,01. Quanto ao tipo cirúrgico o mais prevalente é a pan-histerectomia abdominal (330), seguida de histerectomia abdominal total (255). Das patologias mais prevalentes analisadas, conluiu-se que a única onde ocorreu uma correlaçäo clínico-patológica estatisticamente significativa foi o mioma uterino

Fertility and reproduction following inversion of uterus.

Puerperal inversion of the uterus is itself a rare occurrence. Records of fertility and reproduction following an episode of uterine inversion are even rarer. The reproductive outcome following correction of uterine inversion in 6 cases seen over a span of 35 years is being reported here. One case of acute inversion was managed by manual replacement and the remaining 5 of chronic inversion were corrected by Haultain's operation. The only patient managed by manual replacement conceived thrice. She aborted once, but delivered 2 healthy live babies subsequently by caesarean section done for uterine inertia each time. Out of the 5 patients treated by Haultain's technique, 3 conceived later. One did not come for follow-up after the 5th month. Each of the other 2 had full-term normal delivery of living baby under supervision. None of the cases had any complications. It is concluded that even after operative correction of inversion, uncomplicated delivery may be anticipated. Conservative surgical management is ideal even in apparently neglected and chronic cases, as most of these women were primipara or multipara with only one or 2 living children and had a desire of future child bearing.