11 / 105
U
pdate
on
cesarean
on
request
R
ev
A
ssoc
M
ed
B
ras
2015; 61(4):295
295
B
ernardo
WM
et
al
.
F
elipe
-S
ilva
A
ACCREDITATION
Update on cesarean on request
A
tualização
em
cesariana
a
pedido
S
ergio
F.
de
T
oledo
1
, R
icardo
S
imões
1,2
, R
omulo
P. S
oares
2
, L
uca
S. B
ernardo
2
, W
anderley
M. B
ernardo
2
,
A
ntônio
J. S
alomão
1
, E
dmund
C. B
aracat
1
1
Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo)
2
Guidelines Project, Associação Médica Brasileira
http://dx.doi.org/10.1590/1806-9282.61.04.2951. What is the correct approach to maternal request
for cesarean section?
a.
Know with greater emphasis personal values and pref-
erences of the mother and approach them in a pro-
cess of shared decision.
b.
Perform cesarean delivery without questions and ex-
planations, since this is the patient’s will.
c.
Disregard the patient’s request, since this is a deci-
sion of the doctor exclusively.
d.
Show scientific evidence of the benefits of normal
birth without sharing decision with the patient.
2. Cesarean section onmaternal request or with no in-
dication increases the riskof bleeding complications?
a.
Yes, it increases the absolute risk of bleeding compli-
cations with statistical significance.
b.
Yes, it increases the risk of complications, but with-
out statistical significance.
c.
No, there were no differences in the evaluated results.
d.
No, vaginal delivery increases the absolute risk of bleed-
ing complications in a statistically significant manner.
3. Cesarean section onmaternal request or with no in-
dication increases the riskof infectious complications?
a.
Yes, it increases the absolute risk of infectious com-
plications with statistical significance.
b.
Yes, it increases the risk, but without statistical sig-
nificance.
c.
No, there were no differences in the evaluated results.
d.
No, vaginal delivery increases the absolute risk of infec-
tious complications in a statistically significant manner.
4. Cesarean section on maternal request or with no
indication increases the risk of which outcomes?
a.
Hemorrhagic, infectious and breastfeeding complica-
tions, and respiratory complications for the newborn.
b.
Hemorrhagic and infectious complications, only.
c.
Maternal mortality, surgical wound complications,
neonatal asphyxia, neonatal infection and hospital-
ization in the neonatal ICU.
d.
Bleeding complications, maternal mortality, breast-
feeding complications, and neonatal infection.
5. What is the period when the cesarean section should
be done in case of vaginal delivery refusal?
a.
After 39 weeks.
b.
After 37 weeks.
c.
After 42 weeks.
d.
Before 38 weeks.
A
nswers
to
clinical
scenario
:
birth
route
in
case
of
cesarean
section
in
a
previous
pregnancy
[P
ublished
in
RAMB 2015;
61(3)]
1. What is the level of evidence of studies on birth route
in case of cesarean section in a previous pregnancy?
Observational longitudinal studies and lack of con-
trolled studies (Alternative
A
).
2. The longitudinal observational studies comparing
birth route in patients with cesarean section in a
previous pregnancy are characterized by being:
Heterogeneous in terms of methodology to measure
outcomes and presenting distinct follow-up dura-
tions (Alternative
A
).
3. What are the characteristics associated with a fa-
vorable progress of trial of labor in patients with
previous cesarean section?
Indication of the first cesarean section for non-recur-
ring factor and vaginal delivery history, in the case of
multiparous women with one previous cesarean sec-
tion (Alternative
A
).
4. Trial of labor in patients with previous cesarean
section is:
A reasonable choice for pregnant women with one
previous cesarean section performed by means of
transverse uterine section (Alternative
A
).
5. Which is the birth route indicated for patients
with cesarean section in a previous pregnancy?
There are still doubts about which type of delivery is
better (Alternative
A
).