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Utero-Vesical fistulas are the rarest of all urogenital fistulas, with most cases occurring after cesarean section. Its prevalence is increasing worldwide because of the increasing indications of cesarean section. Patient usually presents with urine leak, amenorrhea and cyclic hematuria. Herein, we present a case of patient presenting with complain of severe urinary tract infection following cesarean section. Review and update of recent literature regarding the diagnostic imaging of this entity are described.

Raha Maroyi,1,2 Bahaya Naomi,2 Madeline K Moureau,3 Balungwe Sifa Marceline,1 Celeste Ingersoll,4 Roselyn Nerville,5 Denis Mukwege1,2,6 1Department of Obstetrics and Gynecology, Panzi Referral Hospital, Bukavu, South Kivu, Democratic Republic of Congo; 2Université Evangélique en Afrique (UEA), Bukavu, South Kivu, Democratic Republic of Congo; 3Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 4Department of Statistics, Brigham Young University, Provo, UT, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6International Center for Advanced Research and Training (ICART), Bukavu, South Kivu, Democratic Republic of CongoCorrespondence: Raha MaroyiUniversité Evangélique en Afrique (UEA), PO Box: 266, Bukavu, South Kivu, Democratic Republic of CongoTel +243 997 254 812Email ken.raha01@gmail.comPurpose: We sought to determine the success rate of VBAC and factors associated with achieving VBAC at a referral hospital in the Democratic Republic of Congo in women with a subsequent pregnancy greater than or equal to 18 months from their primary cesarean section (CS).Patients and Methods: Patients were included for participation if they had an inter-delivery interval (IDI) of at least 18 months from their primary CS, accepted TOLAC, and had no contraindications. Information was collected about patients’ demographics, obstetric history, and factors impacting their labor process. Descriptive analyses compared patients that had a successful VBAC and those who did not. Univariate and multivariate binary logistic regression models identified factors associated with a successful VBAC.Results: Among 231 eligible patients who attempted a VBAC, 57.6% (133) achieved VBAC. Participants had a mean age of 29 (SD 6), with the majority having a prior vaginal delivery (68.8%). VBAC was positively associated with a higher Bishop score (AOR 1.12, 95% CI 1.02, 1.23) and a spontaneous labor onset (AOR 3.06, 95% CI 1.52, 6.17). VBAC was negatively associated with a macrosomic fetus (AOR 0.21, 95% CI 0.08, 0.58).Conclusion: TOLAC results in VBAC more than half the time and is associated with a spontaneous labor onset and a higher Bishop score. Women with a macrosomic fetus were more likely to have an unsuccessful VBAC, resulting in an RCS. An optimal IDI was not enough to ensure a successful VBAC. Upon patients’ arrival to the hospital, practitioners should re-evaluate their eligibility to attempt a VBAC based on their Bishop score and if they had a spontaneous labor onset to decrease the health risks of an RCS.Keywords: trial of labor, delivery, repeat cesarean section, sub-Saharan Africa, Democratic Republic of Congo

This study was designed to evaluate the outcome of the implemented post-cesarean section (CS) surgical site infection (SSI) prevention protocol in Ahmadi Hospital, Kuwait. A total of 229 women who delivered by elective repeat cesarean section (ERCS) were included in this comparative study: 112 women who delivered by ERCS after the implemented protocol (study group) compared to 117 controls (who delivered by ERCS before the implemented protocol). The outcome include the incidence of post-CS SSI after and before the implemented protocol and the risk factors which may predispose to post-CS SSI. The incidence of post-CS SSI was significantly high in the controls (who delivered by ERCS before the implemented protocol) compared to the study group (who delivered by ERCS after the implemented protocol) (12.8% (15/117) versus 3.6% (4/112), respectively) (P = 0.01). The relative risk (RR) analysis showed that obesity and pregestational diabetes were significant risks for post-CS SSI (RR 0.35 (95%CI; 0.13–0.99) P = 0.04 and RR 0.24 (95%CI; 0.063–0.93) P = 0.03, respectively). In addition, the prolonged rupture of membranes (ROM) before the ERCS, duration of ERCS (more than 1 h), and surgical difficulties/adhesions during the ERCS were significant risks for post-CS SSI (RR 6.0 (95%CI; 1.003–35.9) P = 0.04, RR 6.0 (95%CI; 1.003–35.9) P = 0.04, and RR 6.0 (95%CI; 1.003–35.9) P = 0.04, respectively). The incidence of post-CS SSI after ERCS significantly reduced following the post-CS SSI prevention protocol. Obesity, pregestational diabetes, prolonged ROM, duration of ERCS (more than 1 h), and surgical difficulties/adhesions during the ERCS were definite risks for post-CS SSI.

Background: Many women who need caesarian section in most sub Saharan Africa do not get it or do so too late, thereby resulting in an unnecessary increase in maternal and perinatal adverse outcome. Refusal of caesarian section has been attributed to poverty and sociocultural factors. Objective: The objective of the study was to determine the level of acceptance of repeat cesarean section (CS) among pregnant women attending care in a government-funded health facility with a policy of free maternity care services. Materials and Methods: This cross-sectional study surveyed 157 consecutive consenting antenatal clinic clients with previous CS presenting for booking in Central Hospital, Agbor, Delta State, Nigeria. The women completed a questionnaire with sections on sociodemographic attributes, inquiry about previous CS outcome and associated factors, a desire to accept a repeat CS if clinically indicated in index pregnancy, as well as reasons to decline a repeat CS. Results: The acceptance rate of repeat CS was 54%. Women with two or more previous CS were more likely to accept repeat CS (71.8% vs. 48.3%, prevalence ratio: 1.5; P = 0.02). There was no sociodemographic variable or any event related to the previous CS which was significantly associated with the women's choice regarding repeat CS. The rejection of repeat CS was mainly due to concerns about postoperative pain and being tagged with “failure of womanhood.” Conclusions: The level of acceptance of repeat CS in Central Hospital, Agbor, is low despite the policy of free maternity care. Along with the increasing effort to make health care affordable, attention needs to be paid to the role of patient and community engagement in the form of health education and continuous counseling to address noncost barriers to achieving improved maternal and perinatal health indices.

PURPOSE OF REVIEW The prevalence of cesarean delivery is increasing worldwide despite the advance of Trial of Labor After Cesarean section. In many countries, a history of previous cesarean section is an almost absolute indication for a repeat cesarean section. The purpose of this review was to examine if the perioperative anesthetic management of patients with repeat cesarean section is different from the anesthetic management of patients with primary cesarean section. RECENT FINDINGS This review discusses important topics, such as early diagnosis of cases with a potentially high risk for complications; the need for assessment of patients diagnosed with abnormal placentation; the importance of a multidisciplinary approach that includes interaction of the anesthesiologist, gynaecologist, and invasive radiologist; emphasizing the need for reinforcement of new methods of invasive procedures; management of massive bleeding, use of new technologies, and development of an institutional protocol for management of patients with abnormal placentation. SUMMARY According to this review, we show that the management of patients with repeat cesarean section without abnormal placentation is almost the same as the management of patients for primary cesarean section. Timely diagnosis of patient with abnormal placentation and multidisciplinary approach is crucial for prevention of morbidity or even mortality.

Introduction: The success rate of vaginal birth after cesarean section (VBAC) varies among institutions and health care providers. It is also affected by various antepartum, intrapartum factors as well as the difference in the obstetric population. Objectives: The main aim of the study is to determine the factors that affect the success rate of vaginal birth after cesarean section. This will help us to choose the right patients for VBAC thereby decreasing the complications of an emergency cesarean section. Methods: This is a prospective, cohort study done over a period of twelve months. Based on the patient's preference a total of 211 women were divided into two groups either a trial of labor after cesarean section (TOLAC) or elective repeat cesarean section (ERCS) group. VBAC group was compared with the failed trial of labor group to determine the factors affecting the success rate. Result: The success rate of VBAC was found to be 47.9%. About 15% of failed VBAC was due to the tendency to abandon a TOLAC midway. The success rate of VBAC increased in women with previous vaginal delivery and in those who went into spontaneous labor. Epidural was found to be safe to use in the trial of the labor group. Conclusion: Women with factors that increase the likelihood for vaginal delivery following cesarean section should be motivated well and referred to a tertiary center to improve the success rate as well as to reduce the maternal and fetal morbidity

Introduction: A strategy for reducing the number of cesarean sections is to allow vaginal delivery after cesarean section. Objective: To validate two predictive models, Metz and Grobman, for successful vaginal delivery after a cesarean section. Methods: Retrospective cohort study involving women with previous history of a previous segmental cesarean section, single pregnancy ≥37 weeks and cephalic presentation. The proportion of vaginal delivery in all pregnant women was determined, and it was compared with those (women) with successful delivery after cesarean section. Then, there were elaborated the models, and their predictive capacity was determined by curve-receiver-operator. Results: The proportion of successful delivery in pregnant women with a previous cesarean section and indication of vaginal delivery was 85.64%. The observed proportion of birth for each decile predicted in the Grobman model was less than 15%, except for the 91-100% decile, where it was 64.09%; the area under the curve was 0.95. For the Metz model, the actual successful delivery rate was lower than predicted in scores between 4 and 14, and within expected for a score between 15 and 23; the area under the curve was 0.94. Conclusions: The vaginal delivery rate after cesarean was lower than expected according to the predictive models of Grobman and Metz. The implementation of these models in a prospective way can lead to a higher rate of successful birth. Resumen Introducción: Una estrategia de reducción del número de cesáreas es permitir el parto vaginal después de cesárea. Objetivo: Validar dos modelos predictivos, Metz y Grobman, para el parto vaginal exitoso después de una cesárea. Métodos: Estudio de cohorte retrospectivo con mujeres con antecedente de una cesárea segmentaria previa, embarazo único ≥37 semanas y presentación cefálica . Se determinó la proporción de parto vaginal en todas las gestantes y se comparó con aquellas con parto exitoso después de cesárea, se elaboró los modelos y se determinó la capacidad predictiva de ellos mediante curva-receptor-operador. Resultados: La proporción de parto exitoso en gestantes con cesárea previa e indicación de parto vaginal fue 85.64%. La proporción de parto observado para cada decil predicho en el modelo de Grobman fue inferior al 15%, excepto para el decil 91-100%, en el que fue 64.09%, el área bajo la curva fue 0.95. Para el modelo de Metz, la proporción de parto exitoso real fue menor a lo predicho en puntajes entre 4-14 y dentro de lo esperado para puntaje entre 15-23, con un área bajo la curva de 0.94. Conclusiones: La tasa de parto vaginal después de cesárea fue menor a lo esperado de acuerdo a los modelos predictivos de Grobman y Metz. La implementación de estos modelos en forma prospectiva puede llevar una mayor tasa de parto exitoso.

In our report, we present a case of repeat cesarean section in a 29-year-old Ecuadorian mother who contracted COVID-19 and traveled to the United States during her last trimester of pregnancy. We assembled a multidisciplinary team to safely deliver the mother by cesarean section. She received supportive care for her COVID-19 infection. Infection prevention procedures were based on early available data, and the baby was delivered without complications.

Introduction: Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. Repeat cesarean section has recently increased, partly because of concern about increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery. Among the women who underwent cesarean section in their first delivery, 80-96% had a second surgical delivery. Therefore, the present study aimed to describe the prevalence of repeat cesarean section among Nepali women presented at Kathmandu Medical College and Teaching Hospital who had a previous cesarean section. Methods: This was a descriptive cross-sectional study conducted in Kathmandu Medical College and Teaching Hospital from 1st of February to 31st of May 2020. Ethical approval was taken from the Institutional Review Committee of the Kathmandu Medical College. Convenient sampling was done. All pregnant patients between gestational ages of 37-40 weeks with previous cesarean section admitted for safe confinement were included in the study. Results: Among the 104 women, who had prior cesarean section, 99 (95.19%) had second cesarean section and 5 (4.81%) had vaginal birth after cesarean. The most common indication for the first cesarean section was fetal distress 31 (29.81%) while the indication for the second cesarean section among previously cesarean section women was cephalo pelvic disproportion 39 (39.40%). Conclusions: The proportion of cesarean section in both first and subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who underwent consecutive cesarean section with possible consequent complications.

To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. A descriptive epidemiological study using data from secondary birth records from the Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil. The overall rate of CS was of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs. Over half of the births in Brazil were cesarean sections. The Midwest had the highest CS rates, while the North had the lowest. The largest obstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5. Identificar as taxas de cesárea de acordo com a Classificação de Robson nas cinco regiões do Brasil. MéTODOS: Estudo epidemiológico descritivo utilizando dados secundários obtidos do Departamento de Informática do Sistema Único de Saúde (Datasus) entre 1° de janeiro de 2014 e 31 de dezembro de 2016, incluindo todos os nascidos vivos no Brasil. Cesáreas representaram 56% de todos os nascimentos. A amostra foi dividida em 11 grupos, e partos vaginais foram mais frequentes nos grupos 1 (53,6%), 3 (80,0%) e 4 (55,1%). As maiores taxas de cesárea foram encontradas nos grupos 5 (85,7%), 6 (89,5%), 7 (85,2%) e 9 (97,0%). A taxa geral de cesárea variou de 46,2% no Norte a 62,1% no Centro-Oeste. O grupo 5 representou a maior população obstétrica no Sul, Sudeste e Centro-Oeste, e o grupo 3, no Norte e Nordeste. O grupo 5 contribuiu mais para a taxa geral de cesárea, totalizando 30,8%. CONCLUSãO: Mais da metade dos nascimentos no Brasil ocorreu por cesárea. O Centro-Oeste apresentou a maior taxa, e o Norte, a mais baixa. A maior população obstétrica no Norte e no Nordeste foi o grupo 3, enquanto no Sul, Sudeste e Centro-Oeste foi o grupo 5. Entre todas as regiões, a maior contribuição para a taxa geral de cesárea foi do grupo 5.

Introducción. La cesárea es una operación reservada inicialmente para casos en los que el parto eutócico puede comprometer la vida de la gestante o del producto. Por diversas razones, se ha aceptado a la cesárea como método de parto de elección, aumentando su frecuencia. La OMS estableció un margen de tasa de cesáreas de 15% para las cesáreas primarias, ya que valores mayores no representan una disminución en la morbimortalidad fetal. Mundialmente se ha evidenciado tasas de hasta 21% (países europeos) y, en el Perú, 36% en el año 2015. Objetivos. Determinar la frecuencia e indicaciones más frecuentes de cesáreas en un hospital público docente de Lima. Métodos. Estudio descriptivo, tipo serie de casos, de pacientes sometidas a cesárea y sus indicaciones. Se incluyó a pacientes sometidas a cesáreas, electivas o de emergencia, desde enero 2013 hasta diciembre 2017. Resultados. La cesárea fue realizada con una frecuencia de 50,2%, siendo las indicaciones más frecuentes una cesárea previa y la desproporción cefalopélvica. Conclusiones. El estudio halló que se superó la tasa de cesáreas recomendada por la OMS. La indicación más frecuente en el período estudiado fue la cesárea previa.

Method: The rate of caesarean section was only slightly higher than recommended by the WHO. Most of caesarean sections were emergency caesarean sections. Data on all live births were collected, including type of delivery, and indication was recorded if cesarean section was done. Total, primary, & repeat cesarean section rates were calculated for each year. The cesarean rate was calculated as the number of cesarean births divided by total live births. The rate for each indication was calculated annually as the number of cesarean births performed for each indication per 1,000 live births. Result: These two groups constituted nearly 87.7% of total C-Sections. Only 3.4% of the cases belonged to the elderly age group of above 35 years. Maximum no. of caesarean sections was in multiparous females (54.3%). Out of 550 caesarean deliveries 76.7% were from urban area. Also, result showed that only 68.7% were booked for antenatal care. Conclusion: The rate of cesarean section has increased with time with primary and repeat cesareans both showing an increase. In the primary CS rate, indications like labor arrest disorders & fetal distress show an increase more than the objective indications like malpresentation. In repeat CS, history of 02 or more previous sections & scar tenderness contributed more than the fetal distress. Keywords: Indication, Caesarean

To describe a case of vesicouterine fistula and to review the literature related to this condition. For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed. A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary to medical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment. Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof. Apresentar um caso de fístula vesico-uterina e realizar revisão da literatura sobre esta condição. MéTODOS: Revisão realizada consultando-se as bases MEDLINE, BIREME e LILACS, além das referências dos artigos consultados. Uma mulher de 38 anos, após sua terceira cesárea, no puerpério imediato, apresentou hematúria importante, que foi atribuída a uma dificuldade na dissecção da bexiga durante o procedimento. Seis meses pós-parto, em vez de retomar os ciclos menstruais regulares, apresentou menúria cíclica e amenorreia (síndrome de Youssef). A paciente chegou a apresentar obstrução uretral por coágulos, e permaneceu sem diagnóstico correto até cerca de anos pós-parto, quando este foi feito por cistoscopia. Ela foi então submetida a correção cirúrgica por via abdominal, associada a uma histerectomia, com desaparecimento dos sintomas. A revisão mostrou que tem havido mudança na frequência dos vários tipos de fístulas urogenitais. As fístulas vesicovaginais, normalmente secundárias à má assistência durante o parto, têm sido mais raras, enquanto aquelas secundárias a procedimentos médicos, como as vesicouterinas, têm sido mais frequentes. A causa mais comum deste tipo de fístula é a cesárea, especialmente a de repetição. A apresentação pode ser de amenorreia e menúria e/ou perda urinária. O diagnóstico é feito por um ou mais métodos de imagem ou cistoscopia. O tratamento mais comum é cirúrgico, por via abdominal aberta, laparoscópica, transvaginal ou robótica. Existem relatos de cura com tratamento conservador. CONCLUSãO: As fístulas vesicouterinas têm sido mais comuns devido ao aumento da proporção de cesáreas. Deve-se ter em mente a possibilidade deste diagnóstico e considerá-las uma das possíveis complicações da cesárea.

Objective: We aimed to compare the maternal and neonatal complications in women who had undergone fourth or more cesarean section with to women who had undergone second or third cesarean section.Study Design: 162 women who had four or more cesarean section (study group) and 228 women who had undergone second or third cesarean section (control group) were reviewed retrospectively. Demographic features, obstetric, intraoperative, postpartum and neonatal complications were determined in both groups. Results: The preoperative hematocrit values were lower in study group (35.63.6) than the control group (36.64.3), (p

To investigate factors influencing women's decisions to undergo trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery (ERCD) based on the Multidimensional Health Locus of Control (MHLC), religious observance and family planning.Cross-sectional study of candidates for TOLAC or ERCD at two hospitals in Israel. Eligible women completed a demographic questionnaire and Form C of the MHLC scale.The study included 197 women. Those who chose TOLAC (N = 101) were more religiously observant, wanted more children and had higher Internal and Chance health locus of control. Women who chose ERCD (N = 96) were more likely to be secular and had a higher health locus of control influenced by Powerful Others, notably physicians. Women not influenced by others were more likely to choose TOLAC.A woman's choice of TOLAC or ERCD is influenced by her sense of control over her health, degree of religious observance and number of children desired. Healthcare providers can use this information to better understand, counsel and educate women regarding appropriate delivery decisions. Women who feel in control of their health, educated about delivery options and are less influenced by provider preference, might choose TOLAC; thus, reducing the rate of unnecessary ERCD.

Approximately 90% of mothers with a primary C-section have a subsequent C-section. To date, research has demonstrated that primary C-sections are associated with breastfeeding noninitiation. However, it is unknown if this association persists after the primary C-section. Furthermore, literature has shown a differing relationship between breastfeeding initiations by marital status. Due to the high proportion of women who give birth while unmarried, investigating differences by marital status will add a significant contribution to breastfeeding literature. This study investigates the association between repeat C-section and breastfeeding initiation within marital status groups using a nationally representative cross-sectional survey.Data from the 2004 to 2011 Pregnancy Risk Assessment Monitoring System were analyzed. The sample was restricted to women with a previous singleton live birth who had C-section and whose infant was alive at the time of interview (N = 34,854). Multiple logistic regression analyses were conducted to obtain crude and adjusted odds ratio (AOR) and 95% confidence intervals (CIs).After adjusting for potential confounders, married women who had a repeat C-section were 2.2 times (AOR = 2.16, 95% CI = 1.69-2.77) more likely to never breastfeed compared to women with vaginal birth after caesarean section (VBAC). Similarly, the odds of breastfeeding noninitiation were 76% (AOR = 1.76, 95% CI = 1.47-2.12) higher among women with a repeat C-section compared to women with VBAC. No significant associations were exhibited among nonmarried women.Enhanced educational programs and counseling support may be needed to help families cope with delivery challenges and resulting stressors that may reduce their desire to initiate breastfeeding in the postpartum period.

Cesarean section is the most common surgery performed with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Previous C-section delivery was a major indication for a repeat C-section delivery. The present study aims knowing the intra-operative difficulties encountered by an obstetrician, in this highly evolved surgical procedure called C-section especially in a repeat C-section. It was a Prospective observational study conducted on 60 cases of repeat cesarean section in c/o previous one cesarean section. Difficulties encountered while operating on cases of previous one cesarean section were noted. The intraoperative complications were compared with respect to adhesions (peritoneal, bladder, bowel, omental etc), blood loss, extension of tears over uterus, bladder injury, scar dehiscence, uterine rupture, need for hysterectomy. In present study, following intraoperative morbidities were encountered- adhesions 38.33%, advanced bladder 20%, excess blood loss 10%, placenta accrete was found in 1.67%,thinned out scar seen in 5% . Bladder injury seen in 1.67% patients. No cases of uterine rupture & bowel injury were noted. None of the patient needs caesarean hysterectomy. In modern obstetric practice, objective is safe motherhood and healthy baby by proper management. From present study, it can be concluded that repeat caesarean sections in c/o previous one cesarean section are associated with increased complications which lead to increased maternal morbidity Keywords: Primary Cesarean section , Repeat Cesarean section , Caesarean Section Difficulties.

Cesarean deliveries have risen significantly over the past few decades due to advanced maternal age, defensive obstetric practice, medico-legal concerns, and maternal request. A cesarean section is a life-saving surgical procedure when certain complications arise during pregnancy and labor. However, it is a major surgery and is associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long-term effects that are still being investigated. A major obstetric hazard of repeat cesarean section is the increased risk of uterine scar rupture during pregnancy resulting in high fetal and maternal morbidity and mortality. Also, there are increased risks associated with placenta previa and placenta accreta spectrum. We present a unique case of a woman who underwent her 10th cesarean section which was uncomplicated.

Introduction Rising rates of caesarean section (CS) is an issue of particular concern. Recently, there has been research supporting Vaginal Births After Caesarean (VBAC), which is controversial. In Greece, over half of births in the country are by CS, placing Greece among countries with the highest CS rates. The aim of this study was to investigate the prevalence and the factors associated with VBACs and to compare the maternal/neonatal outcomes with a 'non-caesarean' control group. Methods The data were evaluated and retrospectively gathered on archived singleton births, from medical records of a midwifery-led team, between May 2006 and May 2013. The target group of the study included mothers with a previous CS, who had a second birth. The sample consisted of 71 VBAC women and 583 who had normal spontaneous vaginal delivery (NSVD) as the 'non-caesarean' control group. Results The duration of labour was longer for the VBACs compared with first-time mothers who gave birth naturally (for duration 481-720 min, 27% vs 10.3%, respectively), episiotomy was more common for VBAC (20.7% vs 7.9%), and epidural analgesia was more often for VBAC (68.4% vs 10%). The percentage of 1-min Apgar score in the range 0-7 in the VBAC group was 5%, and there was no significant difference in women who had NSVD (3.6%). The Apgar score in the 5th minute was always above 8 for both groups. Conclusions Severe maternal and neonatal complications are infrequent, and therefore the necessity arises for further continuous studies to ascertain the safety of VBAC.

Objective To identify socio-cultural and clinician determinants in the decision-making process in the choice for trial of labor after cesarean (TOLAC) or elective repeat cesarean section (ERCS) in delivering women. Methods A tailored questionnaire focused on epidemiological, socio-cultural and obstetric data was administered to 133 patients; of these, 95 were admitted for assistance at birth at Fondazione Policlinico Universitario “A. Gemelli” (FPG) IRCCS, Rome, and 38 at S. Chiara Hospital (SCH), Trento, Italy. Descriptive analysis and logistic regression modeling were performed. Results Vaginal birth after cesarean (VBAC) rates were higher at SCH than at FPG (68.4% vs. 23.2%; P Conclusion In the attempt to promote person-centered care, increases in TOLAC/VBAC rates could be achieved by focusing on individual maternal needs. An ad hoc strategy for making birth safer should begin from accurate information at the time of the previous CS.

We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity.We analyzed intra-abdominal adhesions of 672 patients.Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively.Emergency operations and adhesions increased complications.

Background and Objectives The rate of cesarean section (CS) at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania, is currently higher than 50%. Mothers and infants are typically separated immediately after CS. The aims of this study were to develop and implement an early skin-to-skin contact (SSC) after CS protocol and to describe the mothers’ perceptions of early SSC after CS. Design An action research design with a questionnaire survey was used. Setting MNH located in Dar es Salaam, Tanzania. Patients Pregnant women who underwent elective repeat CS from August 2018 to the end of September 2018. Intervention A two-step educational program, which consisted of a training program for the medical staff and an information program for the pregnant women, and early SSC after CS were implemented. Interviews were conducted to examine the participants’ perceptions of SSC after CS. Results A total of 26 pregnant women were recruited, of whom 17 (65%) participated. All 17 mothers answered very satisfied or satisfied of the early SSC after CS using a 5-point scale. The information program for the pregnant women was scored on a 10-point scale (0 = completely useless; 10 = very useful). There were 15 mothers (88%) who scored the program 10 points, and the remaining two mothers (12%) eight points. Some mothers wanted extended times and places of early SSC after CS. Conclusions The developed early SSC after CS protocol facilitated understanding of the perceptions of SSC after CS and may be a promising program for implementing early SSC after CS.

Introduction: Cesarean section is one of the common obstetric procedures done when the childbirth is not anticipated to occur by the normal vaginal delivery. There has been increased rate of cesarean section globally as well as in our country in recent decades. Methods: This descriptive cross-sectional study has been carried out by reviewing a year of data from maternity ward of Paschimanchal Community Hospital, Prithvi Chowk, Pokhara. The total number of delivery, their modes either vaginal or cesarean, indications for the cesarean section and their outcomes were analyzed. The obtained data was entered and analyzed in Microsoft Excel. Results: Total of 257 cases underwent delivery during the study period and 174 (63.27%) were by cesarean section. Oligohydramnios is the most common indication for cesarean section. Around 25 (14.36%) of the women underwent repeat cesarean section. Conclusions: The rate of cesarean section was quite high in our study and further studies are recommended for understanding of causes and other associated factors with it.

Background: Cesarean section is the commonest obstetric procedure done worldwide. Incidence of cesarean section is increasing giving it a term “repeat cesarean section”. Repeat cesarean section makes future obstetrics performances and abdominal exploration risky. After any Laparotomy it is fairly common to develop scar tissue, or adhesion. The scarring and adhesion formation is known to increase the major complications rate from 4.3% to 12.5% depending on the number of previous section. Intra peritoneal adhesions have an incidence of 5.5% to 42.5%. Methods: An observational prospective study was conducted in Obstetrics and gynecology department of Era’s Lucknow Medical College, Lucknow. Total 80 cases of repeat cesarean sections were included. The case histories and intra operative findings were recorded. Results: Intra peritoneal adhesions of varied types were seen in majority of cases, out of which the most commonly seen adhesion was between parietal peritoneum and anterior surface of uterus 24(30%) and adhesion between bladder and uterus 24(30%). Conclusions: Chances of developing adhesions increases with each cesarean section, which leads to increase in morbidity of women. Thus cases of previous cesarean section should be educated about routine antenatal care.

Objective: To compare the obstetric outcomes of cesarean section in women who had a history of four or more previous cesarean sections with those who had a history of two or three previous cesarean sections. Methods: Total 1318 women who underwent repeat cesarean section between January 2013 and January 2016 were retrospectively reviewed. Of these, 244 (18.5%) had previously had four or more cesarean sections (multiple repeat cesarean section group) and 1074 (81.5%) had previously had two or three cesarean sections (control group). Demographic characteristics and obstetric outcomes were compared using the Independent t and chi-square tests. Results: The adhesion rate (p < 0.001), number of blood transfusion (p = 0.044), operation time (p = 0.012), length of hospital stay (p < 0.001) and tubal ligation surgery (p < 0.001) were significantly higher in multiple repeat cesarean section group compared to control group. Conclusion: Although multiple repeat cesarean section are asscociated with adhesion occurrence, higher number of blood transfusion, increased operation time and length of hospital stay, there is no remarkable difference in serious morbidity associated with multiple repeat cesarean section.

Objective Intra-abdominal adhesions are associated with an increased risk of complications during repeat Cesarean section (CS), such as bladder and bowel injury, hemorrhage, infection and hysterectomy. We present a simple sonographic marker, the 'sliding sign' of the uterus, for the prediction of intra-abdominal adhesions in the third trimester of pregnancy in women undergoing repeat CS. Methods This was a prospective observational study of pregnant women with a history of at least one Cesarean delivery evaluated by transabdominal ultrasound during the third trimester of an ongoing pregnancy. In order to diagnose intra-abdominal adhesions, we assessed a sonographic sign, the sliding of the uterus under the inner part of the fascia of the abdominal muscles during deep breathing. Women were considered to be at high risk for severe adhesions if uterine sliding was absent and at low risk in the presence of obvious or moderate uterine sliding. A comparison between sonographic findings and intra-abdominal adhesions observed during surgery was performed. Results Of the 63 patients with one or more previous CS examined, 59 completed the study and underwent CS at our institution. In 16 of the 19 cases assigned to the high-risk group for severe adhesions due to absence of sliding of the uterus, the suspicion was confirmed at surgery. The prediction of low risk for adhesions was confirmed in 35 out of 40 patients. The sensitivity and specificity of the sliding sign in predicting presence of intra-abdominal adhesions in women undergoing repeat CS were 76.2% and 92.1%, respectively. Inter- and intraobserver correlation using Cohen's kappa coefficient were 0.52 and 0.77, respectively. Conclusion Our data show that a simple sonographic sign might be able to discriminate between high and low risk for intra-abdominal adhesions in patients with a history of Cesarean delivery. This technique may aid clinical decisions in patients undergoing repeat CS. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery.

Background: Objective of current study was to study the outcome of trial of vaginal birth after Previous Cesarean Section (PCS) and indications for emergency repeat cesarean section at teaching hospitals in India. Methods: Prospective data was recorded on management practices, associated complications and mortality for a period of 8 months in 2005-2006 at 30 medical colleges/teaching hospitals for delivery. Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824) cesarean section and (10.1%) (n=15664) were the number of previous cesarean section. In 84% (n=13151) had repeat cesarean delivery and 2513 (16%) delivered vaginally. A trial of labor was planned in 4035 (25.8%) women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7%) delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%), foetal distress (25.8%), severe PIH/eclampsia (5.0%), previous 2 CS (0.7%), APH (1.4%) and others (2.7%). In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice.

The frequency of cesarean section as the instrument of decrease in perinatal mortality, in many countries with the high and average level the income I surpassed reasonable limits. The systematized data of foreign authors concerning the most discussed aspects of the problem are submitted: the reasons of the global increase in the level of operational childbirth, consequences for the health of the mother and the newborn, and also ways and expediency of decrease in their level. Robson classification is widely used in international practice. It gives an opportunity to compare the indications for cesarean section in different countries and regions.

Contains fulltext : 174756.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Large practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. MATERIAL AND METHODS: This retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R2 measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the correlation between standardized elective repeat cesarean section and vaginal birth after cesarean rates. RESULTS: In all, 1068 women had a history of cesarean section, of whom 71% were eligible for inclusion. A total of 515 women (67%) had a trial of labor, of whom 72% delivered vaginally. The elective repeat cesarean section rate at hospital level ranged from 6 to 54% (mean 29.8, standard deviation 11.8%). Vaginal birth after cesarean rates ranged from 50 to 90% (mean 71.8%, standard deviation 11.1%). More than 85% of this practice variation could not be explained by risk factors at patient level. CONCLUSION: A large practice variation exists in elective repeat cesarean section and vaginal birth after cesarean rates that can only partially be explained by risk factors at patient level. 8 p.

Despite the consequences for women’s health, a repeat cesarean section (CS) birth after a previous CS is common in Western countries. Vaginal Birth After Cesarean (VBAC) is recommended for most women, yet VBAC rates are decreasing and vary across maternity organizations and countries. We investigated women’s views on factors of importance for improving the rate of VBAC in countries where VBAC rates are high. We interviewed 22 women who had experienced VBAC in Finland, the Netherlands, and Sweden. We used content analysis, which revealed five categories: receiving information from supportive clinicians, receiving professional support from a calm and confident midwife/obstetrician during childbirth, knowing the advantages of VBAC, letting go of the previous childbirth in preparation for the new birth, and viewing VBAC as the first alternative for all involved when no complications are present. These findings reflect not only women’s needs but also sociocultural factors influencing their views on VBAC.

Introduction: In modern Obstetrics, with rising trends of primary Cesarean section (CS) for fetal and maternal interests, pregnancy over the scarred uterus is a challenge to all treating obstetricians. How better the cesarean scar is sutured, its exact fate in next pregnancy is still not measurable. Objective of this study was to evaluate the status of previous cesarean scar during repeat cesarean section (RCS) and calculate the maternal morbidity in those cases in a tertiary hospital. Methods: It was a descriptive, retrospective study conducted at department of Obstetrics of Lumbini Medical College Teaching Hospital. The study was conducted from 15th July 2014 to 14th July 2015. The data were retrieved from the department of Medical Records. Women undergoing RCS were enrolled. The status of scar was evaluated in terms of intact scar, scar rupture, scar dehiscence, thin lower uterine segment, scar placenta previa, and adhesions as indicator of scar integrity. Results: There were 534 (25.4%) CS among 2,098 deliveries during the study period. Ninety one (17.04%) of them were RCS. Elective RCS were 73.6% (n=67), and emergency RCS were 26.4% (n=24). Eighty two (90.1%) women had RCS once and 9 (9.9%) had RCS for second time. Scar was intact in 22 (91.6%), scar dehiscence in 1 (8.3%), scar with adhesions in 1 (8.3%) among emergency RCS and intact in 53 (91.3%) and scar with adhesions in 5 (8.7%) among elective RCS. Among nine women of two RCS, three (37.5%) had thin scar, five (62.5%) had well formed scar, seven (87.5%) had intact scar, and one (12.5%) had scar with adhesion. There was no scar dehiscence and no scar rupture in two RCS women. Adhesions were documented twice higher in women whose primary CS was undertaken outside our hospital. Placenta previa and placenta accreta each were found in two cases. Conclusion: Most of the scars of repeat Cesarean section were healthy with no scar rupture. We can consider trial of labor for scarred uterus with strict vigilance and in need, CS is always at option.

We present a case in which there was optimal management of recurrent cervicovesical fistula. The patient sustained a fistula shortly after a cesarean for cephalopelvic disproportion in the second stage. She underwent an unsuccessful attempt at vaginal repair 3 months postpartum and continued experiencing intermittent urinary leakage through the vagina. She expressed a wish for further childbearing and was counseled to undergo fistula repair at the time of repeat cesarean section. Twenty-seven months after her first delivery, she had a second healthy pregnancy and the repair of her cervicovesical fistula was performed with collagen graft interposition at the time of her elective cesarean section. This case report highlights the importance of surgical timing and comments on various factors that possibly enhance the success of the fistula repair.

Background: As cesarean birth rates continue to rise, more women are faced with the choice of planning a vaginal delivery or a repeat cesarean section after a previous cesarean section. The objective of this prospective study was to study the morbidities and mortality of women attempting a trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (El-RCS).Methods: Prospective data was recorded on management practices, associated complications and morbidity & mortality for a period of 8 months on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/ teaching hospitals for delivery.Results: A trial of labor was planned in 25.8% (4035) women and 34.5% (5399) women underwent elective repeat cesarean section and rest had emergency repeat cesarean section. Overall maternal morbidity due to any cause was 20.7% among El-RCS as compared to 14.2% in TOLAC which was statistically significant (OR: 1.57, CI: 1.41-1.76, P=0.00). Blood loss of more than 1000ml was around 8.0% among TOLAC where as in El-RCS it was 8.8% (OR: 0.89, CI: 0.77-1.94, p=0.14 not statistically significant). Blood transfusion was given in 3.7% in TOLAC where as in El-RCS it was given in 6.5% (OR: 0.56, CI: 0.45-0.68, p=0.00 highly significant). Complication like dehiscence of scar was similar in both groups. Post-operative complication were seen in 2.8% cases in TOLAC where as in El-RCS it was 5.8% (OR: 0.47, CI: 0.38-0.59, p=0.00 highly significant). Uterine rupture was 0.3% in TOLAC where as in El-RCS it was 0.7% (OR: 0.43, CI: 0.21-0.87, p=0.009 statistically significant). Maternal mortality was reported in 0.2% cases of TOLAC as compared to 0.1% cases in El-RCS (p=0.17) which was not statistically significant.Conclusions: Maternal morbidity was found to be more in elective repeat cesarean section than trial of labor after cesarean section.

Background In the literature, the terms “angular”, “interstitial” and “cornual” have often been inappropriately interchanged. The consequence is under-recognition of their differences as well as inaccurate imaging guidelines which do not reliably distinguish them as distinct entities. Angular pregnancies should be considered viable and may be managed to term. Case A woman at 7w5d was transferred for surgical management of a presumed interstitial ectopic pregnancy. Sonography and MRI confirmed an eccentric fundal pregnancy with a thin myometrial mantle of 2–5 mm; the diagnosis of interstitial pregnancy was favored. Upon laparoscopy, the round ligament was displaced lateral to the pregnancy bulge and the diagnosis of angular pregnancy was thus apparent. The pregnancy was continued to term and delivered via repeat cesarean section without incident. Conclusion Angular and interstitial pregnancies are different entities which cannot always be reliably distinguished via imaging alone. Diagnostic laparoscopy may be a final step in determining pregnancy location. Angular pregnancies should be considered potentially viable and may be managed to term., Highlights • Angular, cornual, and interstitial pregnancies are distinct entities. • Medical literature has often confused the terms, creating management dilemmas. • Angular pregnancies are likely under-recognized and should be considered viable. • Angular pregnancies are difficult to diagnose by antenatal imaging alone. • Diagnostic laparoscopy may be needed to distinguish between interstitial and angular location.

To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes.A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007.The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8 weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than that in FCS group (38.9+/-2.1 weeks, all P0.01). The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P0.05). Dense adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P0.01) and uterine rupture (1.0% vs. 0, P0.05) were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups (P0.05).Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.

Objective To determine the delivery mode preferred by pregnant women with 1 previous cesarean delivery and to investigate the relationship between preferred and actual mode of delivery. Method We reviewed the records of 215 women who were delivered in a London hospital with a history of 1 cesarean delivery. Women who planned an elective repeat cesarean section (ERCS) were compared with those who planned a vaginal birth after cesarean (VBAC). Results Although 55.3% chose VBAC overall, only 37.8% of those who chose it were delivered by it, whereas 94.8% of those who chose ERCS were delivered by ERCS. Nonwhite women were more likely to choose VBAC than white women (odds ratio, 3.5; 95% confidence interval, 1.9–6.1) but less likely to be deliver by it (odds ratio, 0.31; 95% confidence interval, 0.14–0.68). Conclusion In this study, VBAC was the method of delivery preferred by most women. Nonwhite women were more likely to choose VBAC over ERCS but less likely to be delivered by VBAC.

Objective. The connection between adhesions and post-operative symptoms is well established. Adhesions are found in nearly half of the women at the time of their repeat cesarean section. For the first time a prospective pilot study has been done in order to evaluate the clinical significance of post-cesarean adhesions. Study design. Fifty women who underwent cesarean section in their first pregnancy were interviewed prior to their repeat operation regarding their symptoms after the first surgery. The clinical history was correlated with the findings during the second intervention. Results. No correlation was found between the clinical symptoms and the operative findings regarding abdominal pains, urinary symptoms, dyspareunia, or dysmenorrhea. Surprisingly, although non-significant, women with adhesions reported fewer postoperative gastrointestinal symptoms than the women with no adhesions. Conclusion. More studies will have to been done, but the analysis of this pilot study supports the hypothesis that adhesions following cesarean section are a unique entity.

Over the last three decades, there is a steady rise in cesarean sections globally [1]. This has mainly happened due to expanding indications for primary cesarean section. We now perform elective CS in almost all breech pregnancies; preterm labor; various pregnancy situations such as associated medical problems, e.g., diabetes, hypertension, and immune problems; IVF pregnancies; advanced age pregnancies; and morbidly obese mothers. These higher rates of primary cesarean sections have led to very high repeat cesarean section rates! In almost all recent surveys for indications for CS, “previous cesarean section” has become the number one indication, contributing to almost 40–50 % of CS. The US data also shows a rise from 21 % to 32 % in 15 years [2]. These factors like previous cesarean section, morbidly obese woman, and preterm elective cesarean section have brought in their wake peculiar situations for the delivery of the baby during CS. We have tried to discuss various difficulties encountered in delivering the baby during CS and various means to minimize trauma to the baby as well as to the mother. We have also outlined current concepts and have enlisted suggestions to ease the delivery of the baby with the evidence base. Difficult fetal extraction occurs in approximately one in ten cesarean deliveries, more commonly seen with preterm, elective, and late intrapartum cesarean sections.

Introduction: Increased prevalence of uterus with prior cesarean sections is due to rising rate of cesarean births worldwide. Birth management after a prior cesarean section is a challenging issue, since medical practices are divergent. Objectives: Analyze pregnancy outcome and management of childbirth from a uterus with one cesarean scar. Setting and method: It was an observational, descriptive and cross-sectional study carried out from December 15, 2014 to September 14, 2015 in the University Clinic of Gynecology and Obstetrics (CUGO) of the National University Teaching Hospital (CNHU-HKM) of Cotonou. It involved 132 female patients. The data were analyzed with Epi Info 7 software. Results: The prevalence of childbirth on uterus with one prior C-section is 7.57%. Patients' mean age was 30 years. Most of them were admitted for second childbirth. Most pregnancies were singleton ones (94.70%). The interval between cesarean section and current childbirth is higher than 24 months in most cases (83.76%). The rate of uterine contraction is low (29.55%); the same applies to the one of vaginal birth (25%). The main indications for repeat cesarean section were narrowing of the pelvis (19.19%), acute fetal distress (14.14%) and renal vascular diseases (11.11%). The maternal and perinatal prognosis for vaginal birth had been better than the one of repeat cesarean section. Conclusion: The challenging issue of childbirth management in women with one prior C-section is still a matter of concern in Cotonou. Some efforts still have to be made to improve technical medical equipment so as to extend the indications for uterine contraction during labor, thereby contributing to reduce the rate of repeat cesarean section.