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¿El parto vaginal es más seguro para los prematuros?
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¿El parto vaginal es más seguro para los prematuros?

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¿El parto vaginal es más seguro para los prematuros?

Los bebés muy prematuros tendrían menos problemas para respirar si nacen por vía vaginal que por cesárea, según sugieren los resultados de un estudio sobre más de 20 000 recién nacidos.

Los autores hallaron que, independientemente de la causa de la cesárea (por complicaciones gestacionales o enfermedad materna, por ejemplo), el parto vaginal tendía a ser más seguro.

"Sospecho que el trabajo de parto, las contracciones y las presiones naturales ayudarían a vaciar los pulmones para que el bebé pueda respirar cuando nace", opinó la autora principal, doctora Erika Werner, de la Facultad de Medicina de Johns Hopkins, Baltimore. "Si el parto vaginal es seguro, debería intentarse", sostuvo.

En Estados Unidos, la tasa de cesáreas aumentó para todos los embarazos. Los CDC estiman que uno de cada tres partos en el 2010 fue por cesárea, comparado con uno de cada cinco en 1996.

El equipo de Werner revisó los certificados de nacimiento y los registros de altas hospitalarias de 20 231 bebés nacidos en Nueva York entre 1995 y el 2003. Todos eran muy prematuros (nacidos entre las semanas 24 y 34 de gestación; el embarazo normal dura entre 37 y 42 semanas). Dos tercios habían nacido por parto vaginal.

Tras considerar la edad, la etnia y las enfermedades maternas, el equipo halló que los bebés por cesárea eran más propensos a tener dificultad respiratoria que los nacidos por parto natural (39 versus 26 %).

Más bebés nacidos por cesárea tuvieron resultados adversos en un test de salud general que evalúa los latidos, los reflejos y el color de la piel a los 5 minutos del parto, según publica el equipo en Obstetrics & Gynecology (doi: 10.1097/AOG.0b013e3182918a7e).

Los autores estiman que habría que haber optado por la cesárea en siete y ocho partos prematuros previstos por vía vaginal para evitar un caso de dificultad respiratoria neonatal.

"Existe la noción de que es mejor el parto vaginal cuando no existe otra indicación, pero es algo que algunos consideran que habría que investigar", opinó el doctor Henry Lee, de la División de Medicina Neonatal y del Desarrollo de Stanford University.

Werner señaló que como los investigadores revisaron registros antiguos, no pudieron controlar todas las diferencia entre las mujeres con parto por cesárea y vaginal, una "enorme limitación" del estudio.

Pero Lee coincidió en que las pruebas apuntan favorablemente al parto vaginal en distintos escenarios.

"Cuando no existe un motivo clínico materno o una indicación precisa por la salud del bebé (de realizar una cesárea) claros, la vía de parto más indicada es la vaginal", sostuvo el especialista.

mayo 10/2013 (Medlineplus)

Werner Erika F, Han Christina S, Savitz David A, Goldshore Matt,  Lipkind Heather S. Health Outcomes for Vaginal Compared With Cesarean Delivery of Appropriately Grown Preterm Neonates. Obstetrics & Gynecology: 7 May 2013,

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