PARTO DE NALGAS
¿Os habéis preguntado alguna vez por qué actualmente se hace cesárea a toda mujer con bebé de nalgas por sistema general?
La razón es que en el año 2000 salió una pieza de investigación que parecía demostrar que los bebés de nalgas que nacían por cesárea tenían menos mortalidad y morbilidad que los que nacían vaginalmente. Esa es la razón de que en el año 2007 no queden casi profesionales con experiencia en el parto de nalgas en el mundo entero.
Tan alegremente como el artículo fue publicado, los obstetras, médicos, cirujanos lo acogieron con los brazos abiertos y se dedicaron con más ahínco a cesarear a cuantas más mejor.
Sin embargo en la actualidad se está estudiando a fondo la cuestión de que el trial no estaba bien hecho, que a largo plazo los bebés nacidos por cesárea han tenido tantas o más complicaciones que los nacidos vaginalmente, y que en el estudio se utilizaron partos vaginales con otras complicaciones como prematuridad, preeclampsia, anomalías, etc, con lo cual el estudio no sería válido. Más info visitar AIMS, Sharing The Skills.
Este es el artículo:
The Lancet 2000; 356:1375-1383
DOI:10.1016/S0140-6736(00)02840-3
Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial.
Dr Mary E Hannah MDCM , Walter J Hannah MD, Sheila A Hewson BA, Ellen D Hodnett PhD, Saroj Saigal MD and Andrew R Willan PhD, Term Breech Trial Collaborative
RESUMEN:
Summary
Background
For 3–4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies.
Methods
At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat.
Findings
Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90·4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56·7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1·6%] vs 52 of 1039 [5·0%]; relative risk 0·33 [95% CI 0·19–0·56]; p<0·0001). There were no differences between groups in terms of maternal mortality or serious maternal morbidity (41 of 1041 [3·9%] vs 33 of 1042 [3·2%]; 1·24 [0·79–1·95]; p=0·35).
Interpretation
Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.
Affiliations
a. Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto
b. Maternal Infant and Reproductive Health Research Unit, Centre for Research in Women's Health, University of Toronto, Toronto
c. Faculty of Nursing, University of Toronto, Toronto
d. Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
e. Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Correspondence to: Dr Mary E Hannah, University of Toronto, Maternal Infant and Reproductive Health Research Unit, Centre for Research in Women's Health, Toronto, Ontario M5G 1N8, Canada