Vía de parto tras una cesárea anterior / Labor after an anterior cesarean section

Objetivo: describir la vía de parto en mujeres con una cesárea anterior. En el caso de la cesárea electiva se describen las causas y en aquellas que intentaron parto vaginal, los factores relacionados con la tasa de éxito o fracaso del mismo. También se estudia la incidencia de complicaciones relacionadas. Material y métodos: estudio de cohortes retrospectivo y descriptivo que incluye a 638 mujeres con antecedente de una cesárea anterior y gestación a término cuya finalización del embarazo tuvo lugar en el Hospital Universitario Puerta de Hierro entre enero de 2012 y enero de 2015. Resultados: de las 638 mujeres seleccionadas, 352 deciden intentar parto vaginal (54,5%), mientras que las 286 restantes (45,5%) optan por una cesárea electiva programada. La tasa de éxito del PVDC es del 81,8%. Se registran porcentajes mayores de éxito en mujeres con partos vaginales previos y con inicio del trabajo de parto espontáneo. Las indicaciones de cesárea electiva más frecuentes son la cesárea anterior practicada hace menos de 18 meses y el no deseo de parto vaginal. Hubo 7 casos de rotura uterina. Conclusiones: dada la alta tasa de éxito de la vía de parto en mujeres con una cesárea anterior., se debe ofrecer este como primera opción siempre que no haya condiciones que la contraindiquen, así como informar a la mujer para que la elección se base en la evidencia científica, haciendo hincapié en los riesgos y beneficios tanto de la vía vaginal como de la repetición de la cesárea (AU)

Objective: Describe the delivery in women with a previous caesarean section. In the case of the caesarean section the causes are described, and in those who tried the vaginal delivery, some factors related to the success or failure rates of it are reflected. Also, the incidence of the related complications is studied. Material and Methods: Retrospective and descriptive study of cohorts that include women with previous caesarean section, which conclusion of the pregnancy was in the Puerta de Hierro University Hospital between January 2012 and January 2015. Results: 54,5% decide to try vaginal delivery, while the rest are programmed caesarean sections. The success rate for PVDC is 81,8%. Higher success percentages are registered in women with previous vaginal deliveries, and with the initial work of spontaneous delivery. The most frequent indications of iterative caesarean section are the caesarean sections practiced less than 18 months before, and the wish to not have a vaginal delivery. There were 7 cases of uterine rupture. Conclusions: Provided the high rate of success on vaginal birth after an anterior cesarean section it must be offered as a first option as long as there is not a condition that contraindicates it, as well as educating and informing the woman so the choice is based on a scientific evidence, and is ethic and fair with her and the sanitary service (AU)

Abnormal SPECT myocardial perfusion imaging during periods of obstructive sleep apnea in morbid obese patients without known heart disease.

OBJECTIVE: Determine the myocardial perfusion characteristics in obstructive sleep apnea and its possible role in cardiovascular damage. METHODS AND PROCEDURES: Fourteen patients from the Obesity Clinic weighing less than 130 kg underwent myocardial perfusion studies using single photon emission computed tomography with technetium 99m-labeled sestamibi during nighttime polysomnographic recordings. Coronary angiograms were performed on patients with suspect of severe coronary obstruction according nighttime myocardial perfusion studies or pharmacological stress carried out during waking hours. RESULTS: All 14 patients manifested myocardial perfusion defects during sleep, affecting an average of 5.5 segments/patient, although only 8 presented ischemic ST segment changes and none demonstrated rhythm or conduction disturbances. Angiographic examination of the 10 patients with the most severe perfusion defects did not reveal significant coronary obstruction, and fewer perfusion defects were documented during daytime scintigraphy. DISCUSSION: In obese patients with obstructive sleep apnea, myocardial perfusion defects appear to occur with highest frequency and severity during nighttime sleep, justifying further investigation in a larger number of patients with obstructive sleep apnea and more significant obesity.