[Trying vaginal delivery in 1000 patients with previous cesarean section in the Antiguo Hospital Civil de Guadalajara]. / Intento de parto vaginal en 1000 pacientes con antecedente de una cesárea previa en el Antiguo Hospital Civil de Guadalajara.

Because of the main justification for practicing a cesarean section is due to a previous cesarean and the rasing rates frequency of this operation, we concluded a descriptive and prospective investigation in order to analize the factibility and security of vaginal delivery after one cesarean section. We include 1000 patients with a past history of one previous cesarean section and with the following main characteristics: normal evaluation of the actual pregnancy and a gestational age of at least 36 weeks of pregnancy, no pelvis stenosis and a normal fetal status. The management were expectant and or with the use of oxitocin, prostaglandin PGEJ, uterionhibition and or amnioinfusion according to medical indication, 679 (67.9%) patients had a vaginal delivery; one ruterine rupture (0.001 x 1000) happened (the place of the rupture were not in the scar of the previous cesarean); two uterine dehicence (0.002 x 1000) of the previous uterine scar; one of this require laparotomy and sture of the dehiscence scar and the other one only require observation. We had two intrapartum fetal dead (0.002 x 1000) on due to the uterine rupture and the other one because of a taquisitolia not corrected by betamimetics. The factibility and security of vaginal delivery after one previous cesarean section is a logical and reasonable strategy in order to decrease the actual high rates of cesarean section. Whenever we try a viginal delivery in a patients with one previous cesarean is imperative to keep in mind that if something is not going well during the attempts we must repeat another cesarean.

[Reduction of the number of cesarean sections from 28% to 13%: does it reduce or increase perinatal maternal mortality: the great doubt?]. / La reducción de cesáreas de 28 a 13% incrementa o no la mortalidad materna y perinatal; la gran duda?

According to the new trends related to decrease the cesarean section rates, we conducted our retrospective investigation in order to investigate if the decrease of the cesarean section from 28 to 13%, affect the perinatal mortality (before labor and during labor) and maternal mortality. The years included in this paper were 1990 and 1995. We justified our investigation because some professional in health, believe that the decrease of the cesarean section produce an increase of the maternal and perinatal mortality. In 1990 and 1995 this were our obstetric activity respectively: 1954 and 1504 cesarean section, 4899 and 9176 vaginal deliveries, 6893 and 10730 alive newborns, 172 and 199 perinatal deaths, and finally 9 and 11 maternal deaths. The comparative statistical analysis is as following: for perinatal mortality CHi2 8.00, p 0.004 and OR 1.33 (1.09-1.66) and for maternal mortality Chi2 0.34, P 0.56 and OR 1.30 (0.50-3.36). The risk of perinatal deaths increased in 1990. In relation to the maternal deaths, the risk of mortality didn't increase in 1995.