Estudo de 2006 destacado pelo ICAN (International Cesarean Awareness Network, Inc.)

Este estudo foi destacado pelo ICAN como sendo um dos 15 principais estudos feitos em 2006 sobre cesarianas.

Risco de Ruptura uterina durante o trabalho de parto em mulheres com uma ou mais cesarianas anteriores. (Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Landon, et al., Obstetrics and Gynecology July 2006; 108:2-3,12-20)

• Estudo do caso: Os autores analizaram se o risco de ruptura uterina é maior em mulheres com várias cesarianas anteriores;
• Conclusão: o ter múltiplas cesarianas anteriores não aumenta o risco de ruptura uterina e os autores salientam que o parto vaginal após cesariana (VBAC) deveria ser uma opção para essas mulheres;

Este é o resumo do estudo na sua forma original:

Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery.

Landon MB, Spong CY, Thom E, Hauth JC, Bloom SL, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM, Gabbe SG; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, USA. landon.1@osu.edu

OBJECTIVE: To determine whether the risk for uterine rupture is increased in women attempting vaginal birth after multiple cesarean deliveries.

METHODS: We conducted a prospective multicenter observational study of women with prior cesarean delivery undergoing trial of labor and elective repeat operation. Maternal and perinatal outcomes were compared among women attempting vaginal birth after multiple cesarean deliveries and those with a single prior cesarean delivery. We also compared outcomes for women with multiple prior cesarean deliveries undergoing trial of labor with those electing repeat cesarean delivery.

RESULTS: Uterine rupture occurred in 9 of 975 (0.9%) women with multiple prior cesarean compared with 115 of 16,915 (0.7%) women with a single prior operation (P = .37). Multivariable analysis confirmed that multiple prior cesarean delivery was not associated with an increased risk for uterine rupture. The rates of hysterectomy (0.6% versus 0.2%, P = .023) and transfusion (3.2% versus 1.6%, P < .001) were increased in women with multiple prior cesarean deliveries compared with women with a single prior cesarean delivery attempting trial of labor. Similarly, a composite of maternal morbidity was increased in women with multiple prior cesarean deliveries undergoing trial of labor compared with those having elective repeat cesarean delivery (odds ratio 1.41, 95% confidence interval 1.02-1.93). CONCLUSION: A history of multiple cesarean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation. Maternal morbidity is increased with trial of labor after multiple cesarean deliveries, compared with elective repeat cesarean delivery, but the absolute risk for complications is small. Vaginal birth after multiple cesarean deliveries should remain an option for eligible women. LEVEL OF EVIDENCE: II-2.