Anesthesia for intrauterine myelomeningocele correction: first successful experience in Peru. Case report
In pregnancies with a diagnosis of fetal myelomeningocele (MMC), studies have shown that prenatal correction, as compared with postnatal correction, results in better outcomes in infancy, requiring less ventriculoperitoneal shunts, and resulting in improved motor function of the lower limbs. However, maternal morbidity, the risk of uterine repair dehiscence, uterine rupture secondary to hysterotomy, and the need for cesarean section are all increased. This case report is the first successful experience of intrauterine repair of a MMC in Peru.
We describe the case of a primigravida at 25 weeks of gestation with a diagnosis of fetal malformation (MMC and Arnold Chiari II syndrome) taken to intrauterine correction of the neural tube defect under general anesthesia plus epidural analgesia.
The use of total intravenous anesthesia associated with nitroglycerine infusion for uterine relaxation, ethylephrine infusion to maintain maternal hemodynamic stability, and adequate postoperative pain management with epidural analgesia was successful in this case.
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