Risk factors for vaginal delivery after cesarean section
- Authors: Kuznetsova N.B.1,2, Ilуasova G.M.1, Bushtyreva I.O.2, Gimbut V.S.2, Pavlova N.G.3
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Affiliations:
- Rostov State Medical University, Ministry of Health of Russia
- Clinic of Professor Bushtyreva LLC
- Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
- Issue: No 10 (2023)
- Pages: 78-85
- Section: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/624678
- DOI: https://doi.org/10.18565/aig.2023.121
- ID: 624678
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Abstract
Objective: This study aimed to identify the risk factors associated with vaginal delivery in women who had previously undergone cesarean section. The analysis focused on clinical data and medical history as well as the course of pregnancy and labor.
Materials and methods: Forty pregnant women with a uterine scar from a prior cesarean section who attempted vaginal delivery were included in this study. Based on the labor outcomes, they were divided into two groups. Group 1 comprised 26 women who underwent vaginal delivery, while group 2 consisted of 14 women who required repeat cesarean section during labor. A comparative analysis was conducted, taking into account clinical data, medical history, and the progression of index pregnancy and labor.
Results: Patients in group 2 exhibited higher weight gain during pregnancy than those in group 1, with values of 12.5 [11, 16] and 10 kg [9; 14], respectively (p=0.045). Additionally, 30.8% of the women in group 1 had a history of previous vaginal deliveries, whereas no patients in group 2 had such a history (p<0.05). The placenta was more frequently located along the anterior uterine wall in group 1 (80.8%) than in group 2 (28.6%) (p=0.002). On admission to the maternity hospital, the minimum thickness of the lower uterine segment in the scar area, as determined by ultrasound, was greater in group 1 than in group 2, measuring 2.35 mm [2; 2.8] and 2.1 mm [1.95; 2.23], respectively (p=0.015). Moreover, women in group 1 were significantly more likely to be admitted with a mature cervix according to the Bishop scale than those in group 2 (p=0.007). The dilation of the internal os was twice as wide in group 1 versus group 2 (p=0.002). Rupture of membranes occurred at term more frequently in group 1 than in group 2 (p=0.03).
Conclusions: Based on our findings, risk factors associated with an unsuccessful attempt at vaginal delivery after cesarean section include a lower uterine segment thickness ≤2.1 mm upon admission, cervical maturity score ≤5 points according to the Bishop scale, dilation of the internal os ≤2 cm upon admission, and early rupture of membranes.
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About the authors
Natalya B. Kuznetsova
Rostov State Medical University, Ministry of Health of Russia; Clinic of Professor Bushtyreva LLC
Email: lauranb@inbox.ru
ORCID iD: 0000-0002-0342-8745
Dr. Med. Sci., Associate Professor, Professor at the Center for Simulation Training; Chief Physician
Russian Federation, Rostov-on-Don; Rostov-on-DonGulmira M. Ilуasova
Rostov State Medical University, Ministry of Health of Russia
Author for correspondence.
Email: gulmirka666@mail.ru
post-graduate student
Russian Federation, Rostov-on-DonIrina O. Bushtyreva
Clinic of Professor Bushtyreva LLC
Email: kio4@mail.ru
Dr. Med. Sci., Professor, Director
Russian Federation, Rostov-on-DonVitaliy S. Gimbut
Clinic of Professor Bushtyreva LLC
Email: vgimbut@gmail.com
ORCID iD: 0000-0002-5608-5328
PhD, Doctor of Ultrasound Diagnostics
Russian Federation, Rostov-on-DonNatalia G. Pavlova
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: ngp05@yandex.ru
PhD, Professor at the Department of Obstetrics, Gynecology and Reproductology
Russian Federation, St. PetersburgReferences
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