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S
imões
R
et
al
.
488
R
ev
A
ssoc
M
ed
B
ras
2015; 61(6):488
B
ernardo
WM
U
pdate
on
cesarean
delivery
and
prematurity
F
elipe
-S
ilva
A
ACCREDITATION
Update on cesarean delivery and prematurity
A
tualização
em
cesariana
e
prematuridade
R
icardo
S
imões
1
, R
icardo
C
arvalho
C
avalli
1
, W
anderley
M. B
ernardo
2
, A
ntônio
J. S
alomão
2
, 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/10.1590/1806-9282.61.06.4881. The indication of cesarean delivery in preterm
pregnancy can be based on three proposals. They
include:
a.
Medically indicated cesarean section.
b.
On mother’s request.
c.
Convenience and preference of the physician.
d.
All of the above are correct.
2. Cesarean section in preterm pregnancy also pre-
sents a particular problem related to surgical tech-
nique, because:
a.
The uterine wall is particularly thinner.
b.
The lower segment may not be formed.
c.
Horizontal incision may be required.
d.
Due to the incision, there is increased risk of uterine
rupture in the postpartum period.
3. Regarding the fetal trauma at birth and maternal
outcomes, it is true that:
a.
There is a significant increase in fetal trauma with
vaginal delivery.
b.
There is no difference in morbidity for women un-
dergoing cesarean section or vaginal delivery.
c.
There is no difference in fetal trauma between cesar-
ean section and vaginal delivery.
d.
There is less morbidity among women undergoing
cesarean delivery.
4. The concept of planned cesarean section in pre-
term deliveries implies:
a.
Accurately diagnosing, and performing a C-section
early in the period of labor, or right before it.
b.
Reduced neonatal morbidity and mortality.
c.
Perform a cesarean section at least 12 hours before
the start of labor.
d.
Indication of cesarean section if there is no progress
with vaginal delivery.
5. Regarding cesarean delivery and prematurity, the
recommendation is:
a.
The patient’s request determines the indication, on
the account of autonomy.
b.
Planned cesarean section in preterm fetuses in cephal-
ic presentation should not be indicated with the pur-
pose of fetal protection.
c.
Is indicated for convenience and preference of the
physician.
d.
There is no specific recommendation and the proce-
dure is at the discretion of the obstetrician.
A
nswers
to
clinical
scenario
:
update
on
elective
cesarean
section
for
term
breech
delivery
[
published
in
RAMB 2015;
61(5)]
1. Regarding term breech delivery, it is correct to af-
firm that:
Nulliparity is an associated factor (Alternative
C
).
2. The term breech trial (TBT), which compared the
elective cesarean section with planned vaginal de-
livery, found:
Reduced risk of neonatal hypotonia with cesarean
delivery (Alternative
A
).
3. In maternal morbidity and mortality, comparing
the elective cesarean section with planned vaginal
delivery, it can be said that:
Results are controversial (Alternative
D
).
4. Regarding neonatal morbidity and mortality, com-
paring the elective cesarean section with planned
vaginal delivery, it can be said that:
Results are controversial (Alternative
B
).
5. What is the recommendation for the mode of
delivery in patients with a term breech preg-
nancy?
Planned vaginal delivery is recommended, in select-
ed cases, and under ideal conditions (professionals
experienced in maneuvers for breech presentation)
(Alternative
A
).