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S
imões
R
et
al
.
390
R
ev
A
ssoc
M
ed
B
ras
2015; 61(5):390
B
ernardo
WM
U
pdate
on
elective
cesarean
section
for
term
breech
delivery
F
elipe
-S
ilva
A
ACCREDITATION
Update on elective cesarean section for term breech delivery
A
tualização
em
cesariana
eletiva
na
apresentação
pélvica
em
gestações
a
termo
R
icardo
S
imões
1
, J
oão
de
D
eus
V
aladares
N
eto
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/10.1590/1806-9282.61.05.3901. Regarding term breech delivery, it is correct to af-
firm that:
a.
Its incidence is 0.5% of pregnancies to term.
b.
It is the fifth most common presentation.
c.
Nulliparity is an associated factor.
d.
The complete presentation is the most common.
2. The term breech trial (TBT), which compared the
elective cesarean section with planned vaginal de-
livery, found:
a.
Reduced risk of neonatal hypotonia with cesarean
delivery.
b.
Increased risk of neonatal seizures with cesarean de-
livery.
c.
Increased perinatal morbidity and mortality with vag-
inal delivery.
d.
Reduced perinatal morbidity and mortality with ce-
sarean delivery.
3. In maternal morbidity and mortality, comparing
the elective cesarean section with planned vaginal
delivery, it can be said that:
a.
There is a significant increase in maternal mortality
with vaginal delivery.
b.
There is a significant increase in maternal morbidity
with cesarean delivery.
c.
There is a reduction of maternal morbidity and mor-
tality with cesarean delivery.
d.
Results are controversial.
4. Regarding neonatal morbidity and mortality, com-
paring the elective cesarean section with planned
vaginal delivery, it can be said that:
a.
There is a significant reduction of maternal mortal-
ity with vaginal delivery.
b.
Results are controversial.
c.
There is a significant reduction of maternal morbid-
ity with cesarean delivery.
d.
There is an increase in maternal morbidity and mor-
tality with cesarean delivery.
5. What is the recommendation for the mode of de-
livery in patients with a TBT?
a.
Planned vaginal delivery is recommended, in select-
ed cases, and under ideal conditions (professionals
experienced in maneuvers for breech presentation).
b.
Cesarean delivery is mandatory in all cases.
c.
Planned vaginal delivery may be indicated provided
that a C-section is contraindicated.
d.
There is no specific recommendation and the proce-
dure is at the discretion of the obstetrician.
A
nswers
to
clinical
scenario
:
update
on
cesarean
on
request
[
published
in
RAMB
2015; 61(4)]
1. What is the correct approach to maternal request
for cesarean section?
Know with greater emphasis personal values and pref-
erences of the mother and approach them in a pro-
cess of shared decision (Alternative
A
).
2. Does cesarean section on maternal request or with
no indication increase the risk of bleeding com-
plications?
Yes, it increases the absolute risk of bleeding compli-
cations with statistical significance (Alternative
A
).
3. Does cesarean section on maternal request or with
no indication increase the risk of infectious com-
plications?
Yes, it increases the absolute risk of infectious com-
plications with statistical significance (Alternative
A
).
4. Does cesarean section on maternal request or with
no indication increase the risk of which outcomes?
Hemorrhagic, infectious and breastfeeding compli-
cations, and respiratory complications for the new-
born (Alternative
A
).
5. What is the period when the cesarean section should
be done in case of vaginal delivery refusal?
After week 39 (Alternative
A
).