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Authors
Advisor(s)
Abstract(s)
Para mulheres com uma primeira cesariana, uma tentativa bem-sucedida de trabalho de
parto oferece várias vantagens distintas e consistentemente reprodutíveis em
comparação com uma cesariana eletiva de repetição, incluindo menos histerectomias,
menos eventos tromboembólicos, menores taxas de transfusão sanguínea e menor tempo
de internamento. No entanto, quando a tentativa de parto após a cesariana falha, a
cesariana de emergência está associada a aumento de rutura uterina, histerectomia, lesão
operatória, transfusão de sangue, endometrite e maior permanência hospitalar.
Este trabalho de investigação tem como principal objetivo avaliar a taxa de sucesso do
parto vaginal após cesariana (PVAC) no Centro Hospitalar Universitário da Cova da
Beira (CHUCB) entre os anos de 2016 e 2020, avaliando alguns dos fatores que
contribuem para o sucesso e/ou insucesso do mesmo.
Após a sua realização, concluiu-se que a taxa de PVAC no CHUCB foi de 35,7%, no
período estudado. Foram observadas elevadas taxas de episiotomia e laceração nos
partos vaginais estudados, que não se traduziram num maior número de complicações
major, nomeadamente lesões perineais graves. A rutura uterina é a complicação mais
temida de uma prova de trabalho de parto após cesariana (PTPAC). No CHUCB existiu
apenas um registo de rutura uterina por uma PTPAC malsucedida. Ainda assim, o PVAC
associou-se a uma menor taxa de complicações graves e menor período de internamento,
que o parto por cesariana após cesariana (PCAC). Relativamente às mortes fetais,
verificou-se uma taxa inferior à de outros trabalhos semelhantes e sem relação com o
tipo de parto.
O corrente projeto de investigação traz alguma evidência que pode ser útil para a
formulação de novos protocolos ou algoritmos de decisão no momento do parto, numa
mulher com uma cesariana prévia.
For women with a first cesarean section, a successful attempt at labor offers several distinct and consistently reproducible advantages compared with a repeat elective cesarean section, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter length of hospital stay. However, when the attempted delivery after cesarean section fails, emergency cesarean section is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis and longer hospital stay. This research work has as main objective to evaluate the success rate of vaginal birth after cesarean delivery (VBAC) at the Centro Hospitalar Universitário da Cova da Beira (CHUCB) between the years 2016 and 2020, evaluating some of the factors that contribute to the success and /or failure of childbirth. IT was concluded that the rate of VBAC at CHUCB was 35.7% during the period studied. High rates of episiotomy and laceration were observed in the vaginal deliveries studied, which did not translate into a greater number of major complications, namely severe perineal injuries. Uterine rupture is the most feared complication of a trial of labor after cesarean delivery (TOLAC). At CHUCB there was only one record of uterine rupture due to an unsuccessful TOLAC. Even so, VBAC was associated with a lower rate of serious complications and shorter hospital stay than elective repeat cesarean section (ERCS). Regarding fetal deaths, there was a lower rate than in other similar studies and unrelated to the type of delivery. The current research project brings some evidence that may be useful for the formulation of new protocols or decision algorithms at the time of delivery, in a woman with a previous cesarean section.
For women with a first cesarean section, a successful attempt at labor offers several distinct and consistently reproducible advantages compared with a repeat elective cesarean section, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter length of hospital stay. However, when the attempted delivery after cesarean section fails, emergency cesarean section is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis and longer hospital stay. This research work has as main objective to evaluate the success rate of vaginal birth after cesarean delivery (VBAC) at the Centro Hospitalar Universitário da Cova da Beira (CHUCB) between the years 2016 and 2020, evaluating some of the factors that contribute to the success and /or failure of childbirth. IT was concluded that the rate of VBAC at CHUCB was 35.7% during the period studied. High rates of episiotomy and laceration were observed in the vaginal deliveries studied, which did not translate into a greater number of major complications, namely severe perineal injuries. Uterine rupture is the most feared complication of a trial of labor after cesarean delivery (TOLAC). At CHUCB there was only one record of uterine rupture due to an unsuccessful TOLAC. Even so, VBAC was associated with a lower rate of serious complications and shorter hospital stay than elective repeat cesarean section (ERCS). Regarding fetal deaths, there was a lower rate than in other similar studies and unrelated to the type of delivery. The current research project brings some evidence that may be useful for the formulation of new protocols or decision algorithms at the time of delivery, in a woman with a previous cesarean section.
Description
Keywords
Anemia Cesariana Parto Rutura Uterina Vaginal