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T
oledo
SF
et
al
.
194
R
ev
A
ssoc
M
ed
B
ras
2015; 61(3):194-195
B
ernardo
WM
U
pdate
on
birth
route
in
case
of
cesarean
section
in
a
previous
pregnancy
F
elipe
-S
ilva
A
ACCREDITATION
Update on birth route in case of cesarean section in a previous
pregnancy
A
tualização
em
via
de
parto
em
caso
de
cesariana
em
gestação
anterior
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
Programa Diretrizes da AMB
http://dx.doi.org/10.1590/1806-9282.61.03.1941. What is the level of evidence of studies on birth
route in case of cesarean section in a previous
pregnancy?
a.
Observational longitudinal studies and lack of con-
trolled studies.
b.
Several randomized controlled trials support the
evidence.
c.
Case reports only.
d.
Expert opinion and narrative reviews.
2. The longitudinal observational studies comparing
birth route in patients with cesarean section in a
previous pregnancy are characterized by being:
a.
Heterogeneous in terms of methodology to measure
outcomes and presenting distinct follow-up durations.
b.
Heterogeneous in terms of follow-up duration and
homogeneous in outcome assessment.
c.
Homogeneous in terms of methodology to measure
outcomes and presenting distinct follow-up durations.
d.
Homogeneous in terms of follow-up duration and
heterogeneous in outcome assessment.
3. What are the characteristics associated with a
favorable progress of trial of labor in patients
with previous cesarean section?
a.
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 section.
b.
There are no characteristics favoring a trial of labor
in this situation.
c.
History of two cesarean sections.
d.
Age greater than 35 years is the only factor to favora-
ble progress.
4. Trial of labor in patients with previous cesarean
section is:
a.
A reasonable choice for pregnant women with one
previous cesarean section (performed by means of
transverse uterine section).
b.
A reasonable option for pregnant women presenting
two previous cesarean sections (longitudinal scar).
c.
Always indicated.
d.
Always contraindicated.
5. Which is the birth route indicated for patients
with cesarean section in a previous pregnancy?
a.
There are still doubts about which type of delivery is
better.
b.
Cesarean delivery is always better.
c.
Vaginal delivery is always better.
d.
It varies with age; for patients older than 35 years,
vaginal delivery is indicated.
A
nswers
to
clinical
scenario
–
treatment
of
isolated
lesions
of
the
posterior
cruciate
ligament
[P
ublished
in
RAMB 2015; 61(2)]
1. What is the recommendation for the conservative
treatment of the posterior cruciate ligament (PCL)
injury?
It is recommended in isolated grade I and II ligament
injuries (Alternative
C
).
2. When is surgical reconstruction of the PCL indi-
cated?
It is recommended in ligament injuries caused by
bone avulsions (Alternative
B
).
3. When surgery is recommended, is single tunnel
PCL reconstruction similar to double tunnel re-
construction?
The functional and subjective results are similar
(Alternative
A
).
4. Is use of homologous grafts recommended for re-
construction of the PCL?
Yes, the results are similar to those of autologous
grafts (Alternative
D
).