How often should ring pessaries be removed or changed in women with advanced POP? A prospective observational study.

INTRODUCTION AND HYPOTHESIS: This study aimed to evaluate the efficacy and safety of ring pessaries under continuous use for > 2 years. Our starting hypothesis was that their use without periodic removal, cleaning or replacement for between 24 to 48 months after insertion is safe and effective. METHODS: This was a prospective observational and descriptive study. One hundred one women who successfully completed the 24 first months of continuous use of a ring pessary were included and monitored for another 24 months. The objectives were to establish the percentage of patients maintaining its use 48 months after insertion, the reasons for discontinuation and the adverse events. Another purpose of this study was to determine the timing of replacement of the vaginal pessary in long-term users. RESULTS: Of the women, 92.1% (93/101) had successful pessary use, and it was discontinued by three patients (2.9%, 3/101); 76.2% (77/101) of the women continued pessary use after the end of the study, and in 16 (15.8%, 16/101) patients, after pessary removal, the prolapse disappeared and did not recur. Forty-five women (48.4%, 45/93) presented some adverse events that required temporary pessary removal. The most common one was an increase in vaginal discharge (73.3%, 33/45). In four women (8.9%, 4/45), the ring pessary was detected embedded in the vaginal epithelium. CONCLUSIONS: Continuous use of a ring pessary can be recommended for 2 years in hysterectomized women and for 4 years in non-hysterectomized women if there are no complications.

Is it safe and effective to maintain the vaginal pessary without removing it for 2 consecutive years?

INTRODUCTION AND HYPOTHESIS: The study was aimed at evaluating the safety and efficacy of ring pessaries without support under continuous use without periodic removal or replacement for the treatment of advanced pelvic organ prolapse (POP) in women for 2 consecutive years. METHODS: This study was a prospective observational study. A total of 123 women were recruited in a tertiary hospital from January 2013 to January 2016. The primary objective was the percentage of patients maintaining the use of the pessary after 24 months. The secondary objectives were the reasons for discontinuation and the adverse events in patients with successful fittings. RESULTS: A total of 115 patients (93.5%) had a successful fitting. Four patients died of non-pessary-related causes during the study and, one patient dropped out the follow-up so that finally, 110 patients were included in the efficacy analysis. Pessary use was maintained by 91.8% of the women at the end of the study. The adverse events rate was low (27.0%). The two main factors of interruption in the pessary use were: age (OR 0.93; 95% CI 0.87-0.99) and history of urinary urge incontinence (OR 0.33; 95% CI 0.11-0.96]). CONCLUSIONS: A high success rate and low adverse events rate were achieved in patients with advanced-stage POP with continuous pessary use for 24 months, indicating that a ring pessary could also be used without periodic removal for at least the first 2 years. This practice could reduce the number of control visits.

Insuficiencia cervical y prolapso de bolsa amniótica "en reloj de arena"en gestante pretérmino / Cervical Insufficiency and Prolapse of an "Hourglass" Amniotic Sac in Preterm Pregnant Women

RESUMEN Introducción: La insuficiencia cervical se concibe hoy día como un proceso biológico continuo con grados progresivos de insuficiencia. La expresión más extrema de la insuficiencia cervical se conoce como "bolsa en reloj de arena". La mayoría de los autores están de acuerdo en recomendar el reposo en cama y realizar cerclaje cervical de emergencia. Objetivo: Presentar el caso de una gestante en la que se logró la reversión del prolapso de las membranas amnióticas en "reloj de arena" con buenos resultados perinatales. Presentación de caso: Paciente de 31 años con antecedentes de parto anterior a las 36,5 semanas, que en los momentos actuales cursa una gestación de 20,6 semanas. Acude a la consulta por dolor en hipogastrio y al examen físico se comprueba que la bolsa amniótica protruye por el orificio cervical externo y presenta una dilatación cervical de 2 cm. Se aplica tratamiento medicamentoso y se reduce el prolapso de la bolsa. Conclusiones: Con el tratamiento conservador se logró una buena evolución de la gestación, con parto eutócico y buenos resultados perinatales(AU)

ABSTRACT Introduction: Cervical insufficiency is conceived today as a continuous biological process with progressive degrees of insufficiency. The most extreme expression of cervical insufficiency is known as "hourglass bag". Most authors agree to recommend bed rest and perform emergency cervical cerclage. Objective: To report the case of a pregnant woman in whom the prolapse reversal of the amniotic membranes in hourglass was achieved with good perinatal results. Case report: A 31-year-old patient who is currently pregnant at 20.6 weeks and has history of childbirth prior to 36.5 weeks. She comes to the consultation complaining of pain in hypogastrium. The physical examination shows that the amniotic sac protrudes through the external cervical orifice and there is 2cm cervical dilation. Drug treatment is applied and the prolapse of the sac is reduced. Conclusions: The conservative treatment achieved good evolution of the gestation, with eutócico childbirth and good perinatal results(AU)

Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study.

INTRODUCTION AND HYPOTHESIS: This study aimed to evaluate the efficacy of the ring pessary compared with surgery as a primary treatment for advanced pelvic organ prolapse (POP) in non-hysterectomized, postmenopausal women. Our starting hypothesis was that the pessary is as effective as and less risky than surgery. METHODS: This study was a prospective observational study, which recruited 171 women with symptomatic advanced POP in a tertiary hospital for 30 months. They were treated according their preference with either surgery [77/171 (45.0%)] or vaginal ring pessary without support [94/171 (55.0%)]. The primary outcomes included the discontinuation of pessary use and the incidence of recurrent prolapse throughout the study. Secondary outcomes included complications categorized according to Clavien-Dindo classification. Descriptive statistics were used for demographic data. The mean and standard deviation were calculated for continuous variables, and continuity correction tests, Mann-Whitney U tests, and Fisher's exact tests were used for categorical variables. RESULTS: There was successful use of a pessary in 84.4% (76/90) of cases, and 89.6% (69/77) of patients did not have prolapse recurrence in the surgical group (>POP-Q 2). In the pessary group, the adverse event rate was 31.6%, and all were Clavien-Dindo grade I. Thirty patients [30/77 (39.0%)] had complications in the surgery group: 14.3% were Clavien-Dindo grade I (11/77), 10.4% were grade II (8/77), and 14.3% were grade III (11/77). CONCLUSIONS: The pessary is effective and has mild adverse events in non-hysterectomized, postmenopausal women with advanced POP.

Mola completa coexistente con feto vivo normal: caso clínico y revisión de la literatura / Complete mole coexisting with a live term fetus: a case report and literature review

La coexistencia de mola completa y feto vivo a término es una entidad raramente reportada en la literatura científica. El diagnóstico de sospecha se establece con la ecografía y la confirmación se logra a través del estudio anatomopatológico de tejidos. Las pacientes con mola completa tienen un riesgo del 12-20% de desarrollar enfermedad trofoblástica persistente, de ahí la importancia del seguimiento estrecho. Presentamos un caso de diagnóstico precoz de mola completa coexistente con gestación normal y revisamos la literatura disponible del tema (AU)

The coexistence of a complete mole and live term fetus is a rare entity seldom reported in the literature. Primary non-invasive diagnosis is usually achieved through ultrasound examination and definitive diagnosis can be achieved when molar tissue samples are available for histopathological examination. Patients with a complete mole have a 12-20% risk of developing persistent gestational trophoblastic disease, hence the importance of close follow-up. We report the early diagnosis of a complete mole coexisting with a normal fetus and also provide a review of the literature on the topic (AU)

Análisis de los factores que influyen en la aparición de efectos adversos en la versión cefálica externa / Analysis of factors influencing the development of adverse effects in the external cephalic version

Objetivos. Establecer la relación existente entre los efectos adversos de la versión cefálica externa (VCE) y diferentes variables relacionadas con la técnica. Material y método. Estudio prospectivo que incluyó a 180 gestantes a las que se realizó una VCE. Analizamos los efectos adversos fetales y maternos observados, y su relación con el resultado final de la versión, la experiencia del obstetra, el tiempo empleado en la maniobra, el número de intentos realizados en la misma sesión y el fármaco empleado como relajante uterino. Resultados. Se obtuvo el éxito de la VCE en el 32,6% de las primíparas y en el 79,19% en multíparas. La tasa global de efectos adversos fue del 28,33%, y fue superior en las versiones que fracasaron, en las de mayor número de intentos fallidos, las de mayor duración de la maniobra y en las que fue utilizado ritodrina como útero-relajante. Conclusiones. Se obtiene una mayor probabilidad de éxito y una menor tasa de efectos adversos en las VCE en las que se realiza un único intento, con una duración total de la maniobra inferior a 5min y empleando salbutamol como relajante uterino(AU)

Objectives. To identify the association between the adverse effects of the external cephalic version (ECV) and several variables related to the technique. Material and method. We performed a prospective study in 180 pregnant women who delivered through the ECV. We analyzed fetal and maternal adverse effects and their association with the final result of the version, the experience of the obstetrician, the time used in the maneuver, the number of attempts performed in the same session, and the drug used as a uterine relaxant. Results. The ECV was successfully performed in 32.6% of primiparas and 79.19% of multiparas. The overall rate of adverse effects was 28.33%, and was higher in versions that failed, those with a greater number of failed attempts, those with longer duration and those in which ritodrine was used as a uterine relaxant. Conclusions. The factors increasing the probability of success and reducing the rate of adverse effects in ECV are a single attempt at the maneuver, total duration of the maneuver of less than 5minutes, and use of salbutamol as a uterine relaxant(AU)

Análisis de dos estrategias para el manejo de la amenaza de parto pretérmino / Analysis of two strategies for the management of threatened preterm labor

Objetivo. Comparar dos formas de abordar el trabajo prematuro de parto. La primera basándonos exclusivamente en criterios clínicos y la segunda empleando como herramientas auxiliares la prueba de la fibronectina y la longitud cervical por ecografía vaginal. Material y métodos. Estudio comparativo de ambas estrategias, enfatizando en costes hospitalarios y resultados perinatales. Para el grupo de estudio, en el que empleábamos ambos marcadores para seleccionar a las mujeres de mayor riesgo, empleamos un grupo prospectivo de 122 gestantes que acudieron de urgencia por amenaza de parto pretérmino (APP), y el grupo control (n=112) formado con una cohorte histórica de gestantes ingresadas por APP. Las gestantes catalogadas como de riesgo bajo para tener un parto prematuro eran dadas de alta en urgencias y controladas de forma ambulatoria. Se estimaron los valores predictivos de ambas pruebas y los resultados medidos fueron la tasa de prematuridad, las complicaciones neonatales, los días de hospitalización y los costes hospitalarios resultantes de la hospitalización, la medicación y las visitas posteriores. Resultados. Los resultados perinatales y las tasas de prematuridad en ambos grupos eran comparables. El uso de los tocolíticos y corticoides se redujo al emplear ambos marcadores. La estancia hospitalaria mediana fue 0 en el grupo de estudio (2,6 días cuando eran hospitalizadas), frente a 5 días en el grupo control. Los costes hospitalarios por paciente fueron de 446.24 € en el grupo de estudio (rango intercuartílico (IQ) 1.390,08) y de 1.634,04 € (IQ 1.092,65) en el grupo control. Conclusiones. Empleando estas técnicas para el diagnóstico del verdadero trabajo prematuro de parto, y obteniendo resultados perinatales comparables, no está justificado el tratamiento universal de aquellas gestantes que consultan de urgencia por APP. Esta estrategia puede conducirnos a un ahorro aproximado de 1.200 € por gestante (AU)

Objective. To compare two strategies for the management of threatened preterm labor (TPL). The first strategy was based on clinical criteria alone, while the second used rapid fibronectin testing and cervical length measured by vaginal ultrasound. Material and methods. We compared the costs and perinatal outcomes of both strategies. In the study group, both markers were used to select women at highest risk. The study group consisted of a prospective group of 122 women attending the emergency department for TPL. The control group (n=112) was composed of a historical cohort of women admitted for TPL. Pregnant women classified as low risk for premature birth were discharged from the emergency department and were monitored on an outpatient basis. The sensitivity and specificity of both tests in predicting preterm labor were estimated. The results measured were prematurity < 37 weeks, neonatal complications, length of hospital stay and costs resulting from admission, medication and subsequent follow-up visits. Results. Prematurity and perinatal outcomes were similar in both groups. The use of tocolytics and corticosteroids was reduced by employing the two markers. The median length of hospital stay was 0 days in the study group (2.6 days among hospitalized patients) and 5 days in the control group. The costs incurred per patient were 446.24 euros in the study group (IQR: 1,390.08) and 1,634.04 euros (IQR: 1,092.65) in the control group. Conclusions. Based on the use of these techniques to select patients with true preterm labor and the similar perinatal results obtained in both groups, we conclude that universal treatment of all women with suspected preterm labor is not warranted. This strategy saves approximately 1,200 € per patient (AU)

Análisis de la variabilidad interobservador en la interpretación de la radiopelvimetría y su utilidad en la práctica obstétrica actual / Analysis of interobserver variability in the interpretation of X-ray pelvimetry and its utility in current obstetric practice

Introducción: La radiopelvimetría es una técnica en desuso porque su utilidad ha sido cuestionada al imputársele directamente un incremento de la tasa de cesáreas. Objetivos: Analizar el impacto de la subjetividad del evaluador en la interpretación y valoración de la radiopelvimetría para determinar su utilidad como prueba complementaria objetiva. Material y métodos: Se ha realizado un estudio prospectivo sobre 113 radiopelvimetrías realizadas en otras tantas gestantes primíparas de forma previa a la inducción del parto. Fueron medidas e interpretadas, independientemente y de forma ciega por tres investigadores de amplia experiencia obstétrica. Resultados: Hubo discrepancia entre los dos primeros investigadores en 60 (45,11%) ocasiones y 49 (36,84%) casos fue preciso que las evaluase el tercer investigador. Conclusiones: La radiopelvimetría carece de valor predictivo para pronosticar la vía del parto por la gran variabilidad interobservador a la que están sometidas su medición y su interpretación (AU)

Introduction: X-ray pelvimetry has been directly associated with an increase in the rate of cesarean sections and consequently this technique has fallen into disuse. Objectives: To analyze the impact of evaluator subjectivity in the interpretation and evaluation of X-ray pelvimetry in order to determine the usefulness of this technique as an objective complementary test. Materials and methods: We carried out a prospective study of X-ray pelvimetry in 113 primiparous pregnant women prior to labor induction. The scans were measured and interpreted independently and blindly by three researchers with wide experience in obstetrics. Results: There were discrepancies between the first two researchers on 60 occasions (45.11%) and assessment by the third researcher was required on 49 occasions (36.84%). Conclusions: X-ray pelvimetry lacks value in predicting delivery route since there is wide interobserver variability in the measurement and interpretation of scans (AU)

Utilidad de la prueba de la fibronectina fetal y de la longitud del c¨¦rvix en la predicci¨®n del parto prematuro en gestantes sintom¨¢ticas / Utility of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions

Objetivo: Evaluar la utilidad de la prueba de la fibronectina fetal (fFN) y de la longitud cervical para la predicci¨®n del parto prematuro, en mujeres que presentan din¨¢mica uterina antes del t¨¦rmino. Material y m¨¦todos: Estudio prospectivo realizado en el Hospital Virgen Macarena de Sevilla, en el que se incluy¨® a 153 gestantes con bolsa ¨ªntegra y amenaza de parto pret¨¦rmino (PP) a las que se les realiz¨®, en el momento de la consulta de urgencia, una cervicometr¨ªa mediante ecograf¨ªa transvaginal y una prueba r¨¢pida de fibronectina. No se procedi¨® a hospitalizar ni a someter a tratamiento farmacol¨®gico a las mujeres con una longitud cervical ¡Ý a 30 mm y una fFN negativa. Resultados: La edad gestacional media al diagn¨®stico fue de 223,02 ¡À 19,98 d¨ªas, y de 267,52 ¡À 14,15 d¨ªas en el parto, siendo la tasa de p < 37 semanas del 23% y la de p < 35 semanas del 7,4%. Hay una relaci¨®n significativa entre la longitud cervical < 30 mm y el p < 37 semanas (OR = 3,68; IC del 95%: 1,53-8,84) y el parto en los siguientes 14 d¨ªas (OR = 5,35; IC del 95%: 1,30-21,95). Asociando ambas pruebas se obtiene una mejor¨ªa discreta en la especificidad para la predicci¨®n del parto prematuro. Conclusi¨®n: La cervicometr¨ªa es el par¨¢metro que presenta mejor especificidad (E) y valor predictivo negativo (VPN) para la predicci¨®n del parto pret¨¦rmino en las gestantes con ametaza de parto prematuro (APP) (AU)

Objective: To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions. Material and methods: A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ¡Ý 30 mm were not hospitalized or treated with tocolytics or corticosteroids. Results: The mean gestational age at diagnosis was 223,02 ¡À 19,98 days, and 267,52 ¡À 14,15 days at delivery. Preterm birth <37 weeks rate was 23% and 7,4% for deliveries <35 weeks. There is an association between cervical length <30 mm and birth <37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth. Conclusion: Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions (AU)

Síndrome de burnout en los ginecólogos del Hospital Universitario Virgen Macarena de Sevilla / Burnout syndrome among gynecologists in the Virgen Macarena University Hospital in Seville (Spain)

Objetivo: Conocer la prevalencia del síndrome de burnout entre los médicos de nuestro servicio. Material y métodos: Estudio transversal anónimo utilizando un cuestionario sociodemográfico y la versión española del Maslach Burnout Inventory. Resultados: Con una tasa de respuesta del 68,7% y 21 cuestionarios válidos, los valores medios fueron 25,5 puntos para el cansancio emocional, 9,1 para la despersonalización y 40,3 para la realización profesional. Encontramos valores altos de cansancio emocional en el 52,3% de los ginecólogos y de despersonalización en el 33,3%, y valores bajos de realización profesional en el 14,2%. Presentaron valores altos en al menos una de las dimensiones el 66,6% de los ginecólogos; en 2 el 33,3% y en las 3 escalas simultáneamente el 4,7%. Conclusiones: Hemos encontrado relación significativa entre algún componente del burnout y el sexo, tiempo de vida profesional, situación laboral, realización de guardias, número de horas trabajadas y consumo de inductores del sueño

Objective: To determine the prevalence of burnout among physicians in our Obstetrics and Gynecology Service. Material and methods: We used an anonymous questionnaire containing items on social and personal variables and the Spanish version of the Maslach Burnout Inventory. Results: Twenty-one valid questionnaires were returned (68.7 % response rate). Mean values were 25.5 points for emotional exhaustion, 9.1 for depersonalization and 40.3 points for low self-esteem. High levels of emotional exhaustion and depersonalization were found in 52.3% and 33.3% of the gynecologists, respectively. Low levels of self-esteem were found in 14.2%. High scores were found in at least one of the dimensions in 66.6% of the gynecologists, in two dimensions in 33.3% and in all three dimensions simultaneously in 4.7%. Conclusions: Significant differences in burnout were found according to sex, time since qualifying, occupational situation, nights on call, hours worked, and somnifacient use

Utilización de métodos anticonceptivos en España por grupos de edad: resultados de 4 encuestas nacionales / Use of contraceptive methods in Spain by age groups: results of four national surveys

Objetivos: Conocer los métodos anticonceptivos utilizados según la edad de las mujeres. Material y métodos: Desde 1997 los autores venimos realizando, en España, una encuesta bienal sobre la utilización de métodos anticonceptivos en las mujeres en edad fértil (15-49 años).Resultados: En el grupo de mujeres adolescentesel método más utilizado es el condón. En el grupode 20 a 29 años, el condón sigue siendo el métodomás utilizado, seguido de la píldora. El grupo de30-39 años es el que más utiliza el dispositivo intrauterino (DIU). En el grupo de mujeres de 40-49 años los métodos quirúrgicos son utilizados hasta por el 28% de las mujeres.Conclusiones: En los últimos 6 años se ha incrementado el uso de métodos anticonceptivos en la población española. Se observan diferenciasen la elección del método anticonceptivo según la edad de las mujeres

Objectives: To determine the use of contraceptive methods according to women’s age.Material and methods: Since 1997, we have conducted a biennial national survey in Spain ofthe use of contraceptive methods among women ofchildbearing age (15-49 years).Results: Among adolescent girls, the most widelyused contraceptive method is the condom. In thegroup aged 20-29 years, the most widely used method continues to be the condom, followed by the contraceptive pill. In the group aged 30-39 years, intrauterine devices are most frequently used than in other age groups. In the group of women aged 40-49 years, surgical methods areused by up to 28% of the women.Conclusions: In the last 6 years, the use ofcontraception in Spain has increased. The choice of contraceptive method differs according to women’s age (AU)

Prolapso de la cúpula vaginal tratado mediante operación de Richter-Amreich asociada a colporrafia anterior / Vaginal vault prolapse treatedwith sacrospinous vault suspension associated with anterior colporrhaphy

Objetivo: Estudiar, de forma prospectiva, la tasa de éxito de la fijación sacroespinosa asociada a la colporrafia anterior, en los casos de prolapso de cúpula vaginal después de una histerectomía. Material y métodos: El mismo cirujano trató a 41 pacientes sin incontinencia urinaria previa mediantela intervención de Richter-Amreich asociada a la colporrafia anterior. Se utilizó el gancho Miya y 2 suturas de poliglactina del calibre 00. Se revisó a todas la pacientes al mes de la operación y anualmente hasta la fecha actual. Consideramos éxito de la intervención la falta de prolapso un mes después de la operación y recaída cuando el prolapso apareció uno o más años después de la cirugía. Los datos de las pacientes se incluyeron en una base de datos y se analizaron estadísticamente con el programa Epi-info 3.3TM. Resultados: Hubo prolapso de cúpula al mes de la intervención en 4 de 41 pacientes (tasa de éxitodel 91,2%). Otras 3 pacientes presentaron un mínimo cistocele (grado 1) y una mujer tuvo un cistocele grado 2 sin descenso del ápex vaginal. No ha habido empeoramiento de las pacientes en las revisiones anuales. La complicación más frecuente de la intervención fue la anemia, presente en 13 pacientes (31,7%). La duración media de la intervención fue de 102 ± 35 min, y hubo una clara correlación entre el tiempo operatorio y la experiencia del cirujano. Conclusiones: Se deduce que, en nuestra experiencia, esta técnica es un método efectivo, seguro y económico para solucionar el prolapso de cúpula vaginal tras una histerectomía, especialmente, cuando la experiencia del cirujano supera las 20 intervenciones

Objective: To study prospectively the succes rate of the sacrospinous vault suspension, using the vaginal approach associating an anterior colporrhaphy, in the cases of posthisterectomy vaginal vault prolapse. Material and methods: Between January 1999-July 2005, 41 patients without urinary incontinence and vaginal vault prolapse were treated with the Richter-Amreich’s procedure associated with anterior colporrhaphy by the same surgeon. We have used the the Miya hook in all interventions and 2 sutures of Polyglactin 00. Every patient was 393 followed up a month after the operation and anually till now. We considered success as the lack of prolapse a month after the intervention, and relapse when another prolapse happened in a year or more after surgery. Patients were include in a database and Epi-info 3.3TM was used to perform the statistical analysis.Results: There were vaginal vault prolapse at 1- month follow-up in 4 of the 41 (success rate of 91.2%). Another 3 patients presented minor cystocele (grade 1), and one had a grade 2 cystocele without descent of vaginal apex (9.8%). There is no worsening of these cases till now in the annual follow-ups. The most common postoperatory complication was anemia, that was present in 13 patients (31,7%). The length of complete surgery was 102 ± 35 minutes. There is a clear correlation between operating time and surgeon experience. Conclusions: This technique is an effective method, economic and safe to treat posthysterectomy prolapse of the apical vaginal compartment

Agenesia ovárica unilateral: utilidad de la histerosalpingografía para el diagnóstico etiológico. A propósito de un caso / Unilateral ovarian agenesis: usefulness of hysterosalpingography for etiological diagnosis. A case report

La ausencia de ovario y trompa unilateral es un hallazgo extremadamente raro. Sus posibles etiologías son la ausencia congénita y la torsión subaguda con autoamputación. Se presenta el caso de una paciente que consulta por infertilidad y en el que tras observar repetidamente mediante ecografía una imagen quística en el anejo derecho, y en la histerosalpingografía una imagen compatible con la existencia de la trompa homolateral, se halló en la laparoscopia una ausencia de ovario derecho con la presencia de un seudoquiste y sin una imagen clara de trompa de Falopio. Se realiza una revisión de la bibliografía y se propone como posible etiopatogenia una torsión asintomática con posterior necrosis del ovario

Unilateral absence of a uterine tube is an extremely rare finding. There are two possible etiopathogenic causes: the absence may be congenital or the result of an asymptomatic torsion of the uterine tube. We present the case of a woman who consulted for infertility. Sonography repeatedly showed a cystic image in the right adnexal area, while hysterosalpingography showed an image compatible with the presence of the homolateral uterine tube. However, laparoscopy did not clearly show the uterine tube, and instead of locating the right ovary, a pseudocyst was found. A review of the literature is provided and asymptomatic torsion with subsequent necrosis of the ovary as the possible etiopathogenesis of this case is proposed