Uterine scar: cesarean section or vaginal birth? Impact on reproductive outcomes

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Objective: To study the criteria used to select pregnant women with a uterine scar following a cesarean section (CS) for vaginal birth (VB) in level 2 maternity hospitals and to evaluate the effectiveness of these criteria in relation to birth outcomes.

Materials and methods: This study was conducted at Maternity Hospital No. 3, a level 2 maternity hospital in Tyumen, which provides specialized, round-the-clock medical care for pregnant women. The study included 182 pregnant women with uterine scars from one CS who were observed between 2021 and 2023. Depending on the birth outcomes, the patients were divided into three groups: Group 1 included 85 women with a uterine scar who gave birth vaginally; group 2 included 45 women with a uterine scar who were admitted for VB but ultimately gave birth via CS (unsuccessful VB); and group 3 included 52 women with a uterine scar who underwent CS immediately. Clinical and anamnestic data, as well as the course of pregnancy and childbirth, were compared between these groups.

Results: The primary reason for operative delivery among pregnant women with uterine scars was the refusal of VB by the patients (n=45, 86.0%). Reasons for refusal included concerns about the child’s health due to complications, such as fetal hypoxia (n=20, 44.4%), labor dystocia (n=19, 42.2%), clinically narrow pelvis (n=4, 8.9%), and premature rupture of membranes (n=2, 4.4%). A comparison of successful and unsuccessful VB attempts that ended in surgical delivery revealed no statistically significant differences between the two patient groups in terms of maternal age, body mass index, time since the last childbirth, or gestational age. However, the gestational age was significantly lower in cases of VB refusal than in those with successful VB. The parity at birth was statistically significant. Most patients in the successful VB group had two or more previous births, whereas more than two-thirds of the births in the unsuccessful VB group had only second births (p=0.04).

Conclusion: Reproductive experience suggests that vaginal delivery is the better option. Careful monitoring of these births aids in the development of effective criteria for successful VB in women with uterine scars, thereby increasing their chances of having multiple children and addressing urgent demographic policy issues.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Elena Mateykovich

Tyumen State Medical University of the Ministry of Health of the Russian Federation; Maternity Hospital No. 3

Хат алмасуға жауапты Автор.
Email: mateykovichea@tyumsmu.ru
ORCID iD: 0000-0002-2612-7339

PhD, Associate Professor, Director of the Institute of Maternity and Childhood

Ресей, Tyumen; Tyumen

Irina Karpova

Tyumen State Medical University of the Ministry of Health of the Russian Federation

Email: karpovai.73@mail.ru
ORCID iD: 0000-0001-8688-5695

PhD, Associate Professor at the Department of Obstetrics and Gynecology, Head of the Center of the Scientific and Clinical Center of Geostasis and Genetics of the Multidisciplinary University Clinic

Ресей, Tyumen

Tatyana Shevlyukova

Tyumen State Medical University of the Ministry of Health of the Russian Federation

Email: tata21.01@mail.ru
ORCID iD: 0000-0002-7019-6630

Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology

Ресей, Tyumen

Inna Topchiu

Tyumen State Medical University of the Ministry of Health of the Russian Federation; Maternity Hospital No. 3

Email: zula08061998@yandex.ru
ORCID iD: 0000-0002-3149-8660

PhD student at the Department of Obstetrics and Gynecology

Ресей, Tyumen; Tyumen

Olga Bratova

Tyumen State Medical University of the Ministry of Health of the Russian Federation; Maternity Hospital No. 3

Email: rd3@med-to.ru

Chief Physician, Teaching Assistant at the Department of Obstetrics and Gynecology

Ресей, Tyumen; Tyumen

Roman Marchenko

Perinatal Center

Email: marchenkorn@med-to.ru
ORCID iD: 0000-0002-2073-8120

Head of the Obstetrics Department, Teaching Assistant at the Department of Obstetrics and Gynecology

Ресей, Tyumen

Valentina Polyakova

Tyumen State Medical University of the Ministry of Health of the Russian Federation

Email: polycova_gyn@mail.ru
ORCID iD: 0000-0001-7008-1107

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology

Ресей, Tyumen

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Әрекет
1. JATS XML
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2. Fig. 1. Number of births and frequency of CS in the Russian Federation (Rosstat)

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3. 2. The number of births in the Tyumen region (2016-2024)

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4. Fig. 3. Frequency of CS in the Tyumen region (number of CS per 100 births, 2016-2024)

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