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Abstract(s)
Introdução: O parto vaginal, após uma cesariana anterior (PVAC), tem sido descrito por vários autores como seguro e com uma taxa de sucesso de 72 a 76%. Deste modo, esta prática tem sido implementada como estratégia para redução das cesarianas de repetição, pondo final à máxima vigente no século passado que referia: uma vez cesariana, para sempre cesariana. Porém, prever o sucesso de PVAC ainda é uma tarefa difícil devido à inexistência de uma ferramenta de previsão validada. Ainda poucos estudos preditivos de sucesso de PVAC foram realizados, sendo a generalização uma dificuldade constante devido às diferenças ao nível de condições hospitalares. Desta forma, avaliar os fatores associados ao sucesso de parto vaginal pós cesariana é muito importante para aconselhamento materno e implementação desta prática. Assim, este trabalho tem como objetivo analisar a taxa de sucesso de PVAC entre os anos de 2011 e 2012 no Centro hospitalar Cova da Beira (CHCB), bem como os factores associados ao sucesso do mesmo.
Materiais e Métodos: Estudo retrospetivo, descritivo e analítico, do tipo série de casos de mulheres com cesariana prévia, que realizaram partos nos anos de 2011 e 2012 no Centro Hospitalar Cova da Beira (CHCB). O estudo foi realizado com base em dados obtidos por consulta dos processos clínicos e livro de partos do Serviço de Saúde da Criança e da Mulher do CHCB. O grupo de estudo foi formado por mulheres que realizaram PVAC e o grupo comparativo, formado por mulheres que realizaram parto por cesariana pós cesariana (PCAC).
Resultados: Neste estudo, fatores independentes mostram-se favoráveis para a realização de PVAC como: a ausência de intercorrências obstétricas, início de trabalho de parto espontâneo, um Índice de Bishop elevado aquando da admissão e o recurso a perfusão com oxitocina durante o trabalho de parto. O não cumprimento destes critérios associou-se a falha na realização de PVAC e consequente realização de PCAC. Não se reportou nenhum caso de complicações pós parto nos casos de PVAC, tendo sido reportados 4 episódios de complicações pós parto, todos eles na sequência de PCAC.
Conclusões: Com base nos resultados é possível preparar uma estratégia de decisão referente ao sucesso do parto vaginal após cesárea, tendo em conta o passado obstétrico e o presente desempenho obstétrico da grávida.
Background: Vaginal birth after previous cesarean (VBAC) has been described by several authors as safe and with a success rate of 72-76 %. Thus, this practice has been implemented as a strategy for reducing repetitive cesareans, putting end to the sentence in the last century, which stated: once a cesarean section, always a cesarean section. However, predicting the success of PVAC is still a difficult task due to the lack of a validated prediction tool. Yet few studies of predictive success of VBAC were performed, being the generalization a constant difficulty due to the differences between different hospitals. Thus, to evaluate factors associated with successful vaginal birth after cesarean it is very important to maternal counseling and implementation of this practice. This study aims to analyze the success rate of VBAC between the years 2011 and 2012 in Centro Hospitalar Cova da Beira (CHCB), as well as the factors associated with its success. Materials and Methods: Retrospective, descriptive and analytical study of a case series of women with previous Cesarean section deliveries performed in the years 2011 and 2012 in Centro Hospitalar Cova da Beira (CHCB). The study was based on data obtained by consulting the medical records and the book of deliveries of the department of woman and child health. The study group was composed by women who had VBAC and a comparison group, formed by women who underwent cesarean delivery after previous cesarean delivery (CAPC). Results: In this study, there are independent factors that favour for the realization of VBAC such as: the absence of obstetric complications, spontaneous labor, a high Bishop score on admission and the use of oxytocin infusion during labor. Failure to meet these criteria was associated with a failure to make VBAC and consequent realization of CAPC. There were no reported cases of postpartum complications in cases of VBAC and 4 episodes with postpartum complications have been reported, all of them following CAPC. Conclusions: Based on the results it is possible to prepare a strategy decision on the success of VBAC, taking into account the past and present obstetric performance of pregnants.
Background: Vaginal birth after previous cesarean (VBAC) has been described by several authors as safe and with a success rate of 72-76 %. Thus, this practice has been implemented as a strategy for reducing repetitive cesareans, putting end to the sentence in the last century, which stated: once a cesarean section, always a cesarean section. However, predicting the success of PVAC is still a difficult task due to the lack of a validated prediction tool. Yet few studies of predictive success of VBAC were performed, being the generalization a constant difficulty due to the differences between different hospitals. Thus, to evaluate factors associated with successful vaginal birth after cesarean it is very important to maternal counseling and implementation of this practice. This study aims to analyze the success rate of VBAC between the years 2011 and 2012 in Centro Hospitalar Cova da Beira (CHCB), as well as the factors associated with its success. Materials and Methods: Retrospective, descriptive and analytical study of a case series of women with previous Cesarean section deliveries performed in the years 2011 and 2012 in Centro Hospitalar Cova da Beira (CHCB). The study was based on data obtained by consulting the medical records and the book of deliveries of the department of woman and child health. The study group was composed by women who had VBAC and a comparison group, formed by women who underwent cesarean delivery after previous cesarean delivery (CAPC). Results: In this study, there are independent factors that favour for the realization of VBAC such as: the absence of obstetric complications, spontaneous labor, a high Bishop score on admission and the use of oxytocin infusion during labor. Failure to meet these criteria was associated with a failure to make VBAC and consequent realization of CAPC. There were no reported cases of postpartum complications in cases of VBAC and 4 episodes with postpartum complications have been reported, all of them following CAPC. Conclusions: Based on the results it is possible to prepare a strategy decision on the success of VBAC, taking into account the past and present obstetric performance of pregnants.
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Keywords
Cesariana Complicações Parto Rotura Vaginal