SimõeS R et al. 196 rev assoC Med bras 2015; 61(3):196-202 GUIDELINES IN FOCUS Birth route in case of cesarean section in a previous pregnancy via de parto eM caso de cesariana eM gestaÇÃo anterior Authorship: Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo) and Associação Médica Brasileira (AMB) Participants: The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize

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... s to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient. introduction Over the past decades, the increase in cesarean section rates worldwide, especially in developed countries, has been evident. Nearly a third of all births in the US occur by cesarean section and the proportion of both, first cesarean and repeat cesarean, is still increasing every year (A) 1 (D). 3 Cesarean delivery is a relatively simple procedure, but with inherent risks to its indication that predispose to various complications such as puerperal infection, ectopic pregnancy and thromboembolic events, especially when repeated. The risk of maternal death is increased, as much as the occurrence of infection, hemorrhage and anesthetic complications, which also increases maternal morbidity compared to vaginal delivery. Late complications, especially poor placental implantation in the subsequent pregnancy (placenta with low insertion and varying degrees of placenta accreta), are directly related to a history of cesarean section (B). 2 Maternal morbidity increases in response to each additional cesarean section, especially for women with three or more cesarean sections who have a high risk of low insertion placenta, placenta accreta and hysterectomy (A). 1 With regard to the fetus, although cesarean section can save lives if indicated due to cord prolapse, placenta previa, cephalopelvic disproportion and fetal distress, for example, it can also lead to increased risk of iatrogenic prematurity and neonatal respiratory distress when performed without a precise indication (B). 2 Nevertheless, even though the complications related to trial of labor (TOL) in pregnant women with previous cesarean section are minimal, they are not ruled out and must, thus, be taken into consideration.