Incarceración y torsión uterina en gestante / Incarceration and uterine torsion in a pregnant woman

La torsión uterina es un evento raro, más aún cuando se produce en ausencia de embarazo. Se define como una rotación de más de 45° sobre el eje longitudinal uterino, y habitualmente tiene lugar a lo largo de la transición entre cuerpo y cérvix. En 2 tercios de los casos se produce hacia el lado derecho. Normalmente, está causada por la presencia de una condición anormal o patología que afecta al útero y/o a las estructuras adyacentes. Las manifestaciones clínicas pueden ser agudas, crónicas, o incluso un cuadro asintomático, constituyendo entonces un hallazgo intraoperatorio. La confirmación diagnóstica se realiza únicamente durante la realización de la laparotomía. La congestión de vasos en el ligamento ancho y la colocación anterior de los ovarios, hacen que la histerotomía baja realizada habitualmente en la cesárea no pueda realizarse en determinadas situaciones, optando por una histerotomía clásica en la superficie posterior del útero (AU)

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed (AU)

Fetal spina bifida repair--current trends and prospects of intrauterine neurosurgery.

Myelomeningocele is a common dysraphic defect leading to severe impairment throughout the patient's lifetime. Although surgical closure of this anomaly is usually performed in the early postnatal period, an estimated 330 cases of intrauterine repair have been performed in a few specialized centers worldwide. It was hoped prenatal intervention would improve the prognosis of affected patients, and preliminary findings suggest a reduced incidence of shunt-dependent hydrocephalus, as well as an improvement in hindbrain herniation. However, the expectations for improved neurological outcome have not been fulfilled and not all patients benefit from fetal surgery in the same way. Therefore, a multicenter randomized controlled trial was initiated in the USA to compare intrauterine with conventional postnatal care, in order to establish the procedure-related benefits and risks. The primary study endpoints include the need for shunt at 1 year of age, and fetal and infant mortality. No data from the trial will be published before the final analysis has been completed in 2008, and until then, the number of centers offering intrauterine MMC repair in the USA is limited to 3 in order to prevent the uncontrolled proliferation of new centers offering this procedure. In future, refined, risk-reduced surgical techniques and new treatment options for preterm labor and preterm rupture of the membranes are likely to reduce associated maternal and fetal risks and improve outcome, but further research will be needed.