Vaginal delivery after two cesarean sections. Is it a safe practice?
DOI:
https://doi.org/10.61997/bjm.v14i1.448Keywords:
c-section, Delivery, Uterine rupture, Obstetric complicationsAbstract
Introducción: Una creencia muy extendida es que una madre que ha tenido una cesárea ya no podrá tener un parto vaginal; sin embargo, hay evidencias de que es posible incluso con dos o más cesáreas anteriores. Objetivo: Describir los resultados del parto vaginal después de una y dos cesáreas previas en un hospital de atención secundaria de Djibouti. Métodos: Se realizó un estudio descriptivo, longitudinal, donde se incluyeron las pacientes con una o dos cesáreas anteriores de más de dos años, en trabajo de parto, sin condición que contraindique el parto transpelviano. Resultados: Todas las pacientes con dos cesáreas previas, y el 96,9 % de aquellas con una cesárea previa, se recibieron con más de 4cm de dilatación cervical. Al aplicar el puntaje de Flamm, 18 de las 33 pacientes con una cesárea previa, tenían alta probabilidad de éxito si se proseguía con el parto vaginal. El éxito global con una cesárea previa fue del 78,8 %, y del 87,5 % con el antecedente de dos cesáreas. Se presentaron 8 complicaciones, y 7 de ella correspondieron a pacientes con una sola cesárea previa. La complicación más frecuente fue la hemorragia postparto inmediato. Conclusiones: La frecuencia de parto vaginal exitoso después de una o dos cesáreas fue alta. La predicción fue más precisa para el grupo con dos cesáreas previas, aunque en ambos, cuando el puntaje de Flamm fue elevado, el parto vaginal casi siempre fue posible.
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