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Federación Mexicana de Ginecología y Obstetricia, A.C.

2023, Number 05

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Ginecol Obstet Mex 2023; 91 (05)

Clinical-surgical approach in a pregnant patient with complex urological diversion. A case report

Muraoka-Ramírez AM, Camarena-Pulido EE

Language: Spanish
References: 19
Page: 382-388
PDF size: 264.49 Kb.


ABSTRACT

Background: Myelomeningocele is the most common neural tube defect; one case per 1000 live births is reported. It is more frequent in females, resulting in disabling sequelae, including urological sequelae. They can be corrected with different surgical techniques and complex urological derivations that predispose them to repeated urinary tract infections and, when there is pregnancy, maternal-fetal complications and difficulty for surgical access, in case of cesarean section.
Clinical case: Patient 14 weeks pregnant, 27 years old, diagnosed with myelomeningocele and vesicoplasty, with multiple urinary tract infections and preterm rupture of membranes. Termination of pregnancy by cesarean section at 33 weeks, due to fetal conditions. The cesarean section technique was modified so as not to damage the cystoplasty and to avoid complications with adhesions in the pelvis.
Conclusions: The best maternal-fetal prognosis in patients with complex urologic diversion is achieved with the intentional search for urinary tract infections and timely and adequate treatment, in addition to multidisciplinary planning at the time of termination of pregnancy.


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