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Objective: To analyze the success rate of external cephalic version (ECV) in pregnant women with a history of previous cesarean section, as well as to describe the rate of complications associated with the procedure. Methods: A retrospective cohort study of women who were offered an ECV at "Virgen de la Arrixaca" Clinic University Hospital (Murcia, Spain) between January 2014 and December 2023. We collected data for previous cesarean delivery, obstetric history, fetal presentation, amniotic fluid volume, ECV success rate, complications related to ECV, mode of delivery, and neonatal outcomes. The study confidently performed ECV under sedation with propofol and tocolysis with ritodrine. Univariate and multivariate analyses were conducted to compare the success rate of ECV, ECV complications, and mode of delivery between women with and without previous cesarean sections. Results: Of 1116 pregnant women who were offered ECV, 911 were included in the study, with 42 having a previous cesarean section. The success rate of ECV in pregnant women with a previous cesarean section was 78.6% (adjusted odds ratio 1.18; 95% confidence interval 0.49–2.86; P = 0.708), with a low complication rate of 9.5%, such as non‐reassuring fetal heart rate (7.1%) or major vaginal bleeding (2.4%). Of the women who attempted a vaginal delivery after ECV, 80.8% were successful. Conclusions: These findings support that ECV is a safe and effective option for women with a previous cesarean section, with success rates comparable to those in women without a previous cesarean section. Synopsis: Success and complication rates of external cephalic version are similar in women with and women without a history of cesarean section. [ABSTRACT FROM AUTHOR]

Cesarean section (CS) is a life‐saving procedure when performed for the right indication but carries substantial risks, specifically during subsequent pregnancies. The aim of this study was to evaluate obstetric outcomes for women 5 years after a CS performed by medical doctors and associate clinicians. This was a prospective multi‐center observational study of women who had a CS at any of nine hospitals in Sierra Leone. Women and their offspring were followed up with three home visits for 5 years after surgery. Outcomes of interest included long‐term complications, mode and place of delivery, and maternal and pediatric outcomes of subsequent pregnancies. Of the 1274 women included in the study, 140 (11.0%) were lost to follow‐up. Within 5 years after the index CS, 27.0% of the women became pregnant and 2.5% had a second pregnancy. Women with perinatal death at the index CS had 5.25 higher odds of becoming pregnant within 1 year. Of the 259 women who delivered, 31 (12.0%) had a planned CS and 228 (88.0%) attempted a trial of labor after CS, resulting in either a successful vaginal birth (n = 138; 60.5%) or an emergency CS (n = 90; 39.5%). Peripartum and long‐term complications did not significantly differ between those that were operated on by medical doctors and associate clinicians. Within 5 years after CS, one in four women became pregnant again and more than half had a vaginal delivery. Significant differences in place and mode of birth between wealth quintiles illustrate inequities. [ABSTRACT FROM AUTHOR]

Background: Cesarean sections are becoming more commonplace worldwide. The World Health Organization (WHO) advised utilizing the Robson categorization system to assess and monitor the frequency of cesarean procedures overtime, both within and between healthcare facilities. Aims and objectives: To determine the pattern of obstetric women population. To find which proportion of women have a high CS rate will help us to target specific groups of women for the reduction of overall CS. Materials and Methods: This investigation was observational. From September 2022 to August 2023, all cesarean deliveries at Government Medical College, Mahasamund, Chhattisgarh, India, having a gestational age of more than 28 weeks, were included. After using Robson's TGCS, data were entered, examined, and shown as percentages. Results: A total of 3,573 deliveries happened in the study period. Approximately 41.26% of births were cesarean. Women who are nulliparous (46.36%) outnumber those who are multiparous (23.55%). The main relative contributors to the 80.18% overall CS rate were groups I, II, and V. Group VI had a breech, nulliparous CS rate of 82.86%, group IX had a high CS rate of 100%, and group V had a prior CS rate of 94.75%. Conclusion: The findings show that group V had a high CS rate; therefore, steps must be taken to decrease CS in groups I and II, since a reduction in CS in group I would subsequently result in a reduction in group V's group size. These measures include shared decision-making, equality of care, induction of labor and close monitoring, vaginal birth after cesarean section (VBACS) in selected women under supervised conditions, respectful maternity care, positive pregnancy experience, one-to-one intrapartum care, and appropriate regular training of staff involved in the care of pregnant women. [ABSTRACT FROM AUTHOR]

Background and Objective: Previous cesarean sections are the most common cause of increased cesarean section in many parts of the world, although it is not always necessary. Considering the high statistics of cesarean section in Iran and especially the high rate of repeat cesarean section and creating motivation for vaginal birth after cesarean section, this study was conducted in order to investigate the maternal and neonatal outcomes of vaginal birth after one cesarean section. Methods: This cross-sectional study was conducted on 104 pregnant women with a previous caesarean section and transverse incision on the lower segment in Ayatollah Rouhani Hospital of Babol in two groups; 50 people in the first group who underwent repeat emergency cesarean section and 54 people in the second group who consented to vaginal birth after cesarean section (VBAC). Demographic characteristics and maternal and neonatal complications were investigated and compared between the two groups. Findings: In this study, there were no significant differences between the two groups in terms of demographic characteristics. Infant mortality rate was reported in 6 cases (12%) in the first group and 2 cases (3.7%) in the second group. Furthermore, 3 babies (6%) in the repeat cesarean section group and 9 babies (16.7%) in the vaginal birth group after cesarean section were admitted to the neonatal intensive care unit. The 5-minute Apgar was also significantly higher in the babies of the vaginal birth group after cesarean section (p=0.04). The duration of mother's hospitalization was 3.98±5.53 and 2.11±0.31 days in the repeat cesarean and vaginal birth groups, respectively (p=0.02). Conclusion: According to the results of this study, maternal and neonatal complications did not increase in vaginal birth after cesarean section, and if the mother wishes, vaginal birth can be performed after one cesarean section. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to investigate the level of perinatal anxiety in pregnant women who considered vaginal birth after a cesarean section (VBAC) and evaluate its effect on the type of delivery. SUBJECTS AND METHODS: The study was planned as single-centered and analytical. It was performed with pregnant women planning VBAC, reached via Google Forms between February 23 and August 17, 2022. An online form consisting of the Patient Information Form and the Perinatal Anxiety Screening Scale-Turkish version (PASSTR) was applied to the participants. The type of delivery was questioned by phone call. RESULTS: Ages of 162 pregnant women ranged from 22 to 40 years (mean=31.08±3.75). 54.9% (n=89) had a gestational week of 37 or more. 83.3% (n=135) had a vaginal delivery, and 54.3% (n=88) had a score of >16 on PASS-TR. PASS-TR total and subscale scores were higher in patients with known gynecological diseases (p<0.001). The total score of PASS-TR was higher in those aged between 18-30 years (p=0.027). The total number of pregnancies was higher in those with a PASS-TR score of =16 (p=0.007). There was no statistically significant difference between the total and subscale scores of PASS-TR with the type of delivery after cesarean section. CONCLUSIONS: Perinatal anxiety was determined in 54.3% of the pregnant women planning VBAC, and 83.3% had a successful vaginal delivery. Age, low gravida, and the presence of gynecological diseases were risk factors for anxiety. There was no relationship between the type of delivery after cesarean section and perinatal anxiety. [ABSTRACT FROM AUTHOR]

Filipos Mesay,1 Ergoye Melese,2 Gebiyaw Wudie,2 Sefineh Fenta Feleke,3 Anteneh Mengist Dessie4 1Department of Public Health, Gafat Health Center, Debre Tabor, Ethiopia; 2Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 3Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia; 4Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Sefineh Fenta Feleke; Filipos Mesay, Tel +251928573882 ; Tel +251984929331, Email fentasefineh21@gmail.com; mesayfilipos16@gmail.comBackground: An attempt at vaginal delivery by a woman who has previously had a cesarean section is known as a trial of labor after cesarean section. The most important issues are how to accurately anticipate successful vaginal birth after cesarean surgery and how to calculate the likelihood of success of vaginal birth after caesarean section that is suitable for women. Consequently, a tailored prediction of vaginal birth after caesarean section may result in a more effective counseling.Objective: To create a clinical risk score and prediction model for the success of vaginal birth following a previous caesarean section in women.Methods: A prognostic analysis was carried out at Felege Hiwot Comprehensive and Specialized Referral Hospital from 30 February 2017 to 30 March 2021. R statistical programming language version 4.0 was used for analysis once the data had been coded and entered into Epidata, version 3.02. Significant factors (P< 0.05) were kept in the backward multivariable logistic regression model, and variables with (P< 0.25) from the bi-variable logistic regression analysis were also added.Results: After a cesarean section, 67% of women were successful in giving birth vaginally. Previous successful vaginal birth after cesarean surgery, rupture of the membranes, and initiation time of ANC, the beginning of labor, parity and time since the previous delivery were remained in the final multivariable prediction model. The AUC of the model was 0.748 (95% CI: 0.714– 0.781).Conclusion: Overall, this study demonstrated the likelihood of predicting vaginal birth utilizing the ideal confluence of parity, membrane rupture, and onset of labor, prior history of VBAC, inter-delivery gap, and ANC beginning time. Sixty-seven percent of VBACs were successful. As a result, this model may aid in identifying pregnant women who are candidates for VBAC and who have a better likelihood of success.Keywords: prediction model, vaginal birth after cesarean section, risk score, Ethiopia

Abstract Background The rates of successful vaginal birth after previous cesarean section (VBAC) have been increasing with minimal complication. Successful vaginal birth after cesarean section improves maternal and fetal outcomes by shortening the length of hospital stay, avoiding abdominal surgery, decreasing the risk of infections and hemorrhage, and decreasing injury of the bladder and bowel. Despite a few single studies stating different predictors of successful VBAC, there is a lack of nationwide data to show the determinants of successful VBAC. Thus, this meta-analysis aimed to determine the predictors of successful VBAC in Ethiopia. Methods A systematic literature search was performed from PubMed, Web of Sciences, EMBASE, CINAHL, and Google scholar until July 25, 2022. The quality of included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist. The analysis was executed using Stata 14 statistical software. Heterogeneity was evaluated statistically using Cochran’s Q-statistic and quantified by the I2 value. A random-effects model was used to estimate the determinants of successful vaginal birth after a cesarean section if substantial heterogeneity was detected across included studies; otherwise, a fixed-effects model was used. Results Women living in rural residence (AOR: 2.14; 95% CI: 1.01, 4.52), history of previous spontaneous vaginal delivery (AOR: 2.92; 95% CI: 2.02, 4.23), previous successful vaginal birth after previous cesarean section (AOR: 5.29; 95% CI: 2.20, 12.69), history of stillbirth (AOR: 1.57; 95% CI: 1.20, 2.04), cervical dilation of ≥ 4 cm at admission (AOR: 2.14; 95% CI: 1.27, 3.61), spontaneous ruptured membranes at admission (AOR: 1.32; 95% CI: 1.17, 1.48) were independent determinants of successful vaginal birth after previous cesarean section. Conclusion The results of this meta-analysis showed that successful VBAC was influenced by past and present obstetric conditions and other predictors. Thus, it is recommended that obstetric care providers should emphasize those factors that lead to successful vaginal birth during counseling and optimal selection of women for the trial of labour after cesarean section. Systematic review and meta-analysis registration PROSPERO CRD42022329567.

Rapidly increasing cesarean birth rates around the world continue to cause concern. Repeated cesarean sections are the most important causes of this increase. Vaginal birth after cesarean section (VBAC) is a good solution, but is not used widely enough in clinical practice. This cross-sectional descriptive study aimed to determine the attitudes of healthcare professionals towards VBAC and the factors that affect them. The study was conducted at a maternity hospital in Istanbul and sample included 254 healthcare professionals. The data were collected using a personal information form and the VBAC Attitudes Form. Percentages, means, Pearson’s chi-squared test, the Kruskal-Wallis H test and the Mann-Whitney U test were used. The threshold for statistical significance was p

Background and Objective: Previous cesarean sections are the most common cause of increased cesarean section in many parts of the world, although it is not always necessary. Considering the high statistics of cesarean section in Iran and especially the high rate of repeat cesarean section and creating motivation for vaginal birth after cesarean section, this study was conducted in order to investigate the maternal and neonatal outcomes of vaginal birth after one cesarean section. Methods: This cross-sectional study was conducted on 104 pregnant women with a previous caesarean section and transverse incision on the lower segment in Ayatollah Rouhani Hospital of Babol in two groups; 50 people in the first group who underwent repeat emergency cesarean section and 54 people in the second group who consented to vaginal birth after cesarean section (VBAC). Demographic characteristics and maternal and neonatal complications were investigated and compared between the two groups. Findings: In this study, there were no significant differences between the two groups in terms of demographic characteristics. Infant mortality rate was reported in 6 cases (12%) in the first group and 2 cases (3.7%) in the second group. Furthermore, 3 babies (6%) in the repeat cesarean section group and 9 babies (16.7%) in the vaginal birth group after cesarean section were admitted to the neonatal intensive care unit. The 5-minute Apgar was also significantly higher in the babies of the vaginal birth group after cesarean section (p=0.04). The duration of mother's hospitalization was 3.98±5.53 and 2.11±0.31 days in the repeat cesarean and vaginal birth groups, respectively (p=0.02). Conclusion: According to the results of this study, maternal and neonatal complications did not increase in vaginal birth after cesarean section, and if the mother wishes, vaginal birth can be performed after one cesarean section.

Objective: Trial of labor after cesarean section (TOLAC) is an option for women with previous cesarean section. However, few women choose this option because of safety concerns. We evaluate the safety and risks associated with TOLAC and the success rate of vaginal birth after cesarean delivery (VBAC). Material and methods: We reviewed all patients with a history of previous cesarean section that underwent elective repeat cesarean section (ERCS) or TOLAC in a regional teaching hospital from Nov, 2013 to May, 2018. Maternal basic clinical information, intrapartum management, postpartum complications, and neonatal outcomes were analyzed. Results: 199 pregnant women with a history of at least one previous cesarean section were enrolled. 156 women received ERCS and 43 women (21.6%) underwent TOLAC, with 37 (86.0%) who underwent successful VBAC. The VBAC rate was 18.6%. Higher success rate was found in women with previous vaginal birth than in women without vaginal birth (100% vs. 81.8%). One case (2.3%) in the VBAC group was complicated with uterine rupture and inevitable neonatal death during second stage of labor. The uterus was repaired without maternal complications. In another case, the newborn's condition was complicated with low APGAR score (

Objective: Predicting likelihood of vaginal birth after cesarean (VBAC) is a cornerstone in counseling patients considering a trial of labor after cesarean (TOLAC). Yet, the simplified Bishop score (SBS), a score comprised cervical dilation, station, and effacement assessment used to predict successful vaginal delivery, has not been applied to the TOLAC population. We evaluated the relationship between admission SBS and likelihood of successful VBAC. We also determined the predictive characteristics of SBS, compared to cervical dilation alone, for successful VBAC. Methods: This is a secondary analysis of a prospective cohort study of patients with a singleton gestation, ≥37 0/7 weeks gestation, and prior cesarean admitted to Labor & Delivery between 2010 and 2014. The primary outcome of successful VBAC was compared between those with a favorable (score >5) and unfavorable (score ≤5) admission SBS. Secondary outcomes were select maternal and neonatal outcomes. Adjusted risk ratios were estimated using multivariable logistic regression analyses. Receiver-operating characteristic curves compared predictive capabilities of cervical dilation alone to SBS for successful VBAC. Results: Of the 656 patients who underwent a TOLAC during the study period, 421 (64%) had a successful VBAC. 203 (31%) and 453 (69%) had a favorable and an unfavorable admission SBS, respectively. After adjusting for body mass index and prior vaginal delivery, patients with a favorable admission SBS had a 30% greater likelihood of successful VBAC compared to those with an unfavorable SBS (aRR 1.30, 95% CI 1.16–1.40). Admission cervical dilation alone performed similarly to SBS as a predictor of successful VBAC, with a receiver-operator characteristic curve area under the curve (AUC) of 0.68 (95% CI 0.64–0.72) versus an AUC 0.66 (95% CI 0.62–0.70), respectively (p = .07). There were no differences in adverse maternal or neonatal outcomes between those with an unfavorable and favorable SBS. Conclusions: A favorable admission SBS is associated with an increased likelihood of VBAC. Although both admission SBS and cervical dilation alone are only modest predictors of VBAC, admission cervical dilation performs overall similarly to current models for VBAC prediction and is an objective, reproducible, and generalizable measure. Our study highlights the value of waiting until end of pregnancy (rather than the first prenatal visit) to conclude patient counseling on the decision to TOLAC in order to consider admission cervical assessment, particularly cervical dilation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of a quality improvement project with an educational/motivational intervention in northern Italy on the implementation of the trial of labor after cesarean section (CS). Method: A pre‐post study design was used. Every birth center (n = 23) of the Emilia‐Romagna region was included. Gynecologist opinion leaders were first trained about Italian CS recommendations. Barriers to implementation were discussed and shared. Educational/motivational interventions were implemented. Data of multipara with previous CS, with a single, cephalic pregnancy at term, were collected during two periods, before (2012–2014) and after (2017–2019) the intervention (2015–2016). The primary outcome was the rate of vaginal birth after CS (VBAC) and perinatal outcomes. Results: A total of 20 496 women were included. The VBAC rate increased from 18.1% to 23.1% after intervention (P < 0.001). The likelihood of VBAC—adjusted for age 40 years or older, Caucasian, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) at least 30, previous vaginal delivery, and labor induction—was increased by the intervention by 42% (odds ratio 1.42, 95% confidence interval 1.31–1.54). Neonatal well‐being was improved by intervention; neonates requiring resuscitation decreased from 2.1% to 1.6% (P = 0.001). Conclusion: Educating and motivating gynecologists toward the trial of labor after CS is worth pursuing. Health quality improvement is demonstrated by increased VBAC even improving neonatal well‐being. Synopsis: Educating gynecologists toward trial of labor after cesarean section is an intervention that leads to increasing vaginal birth after cesarean section, even improving neonatal well‐being. [ABSTRACT FROM AUTHOR]

Firehiywot Teferi Mekonnin,1 Gizachew Abdissa Bulto2 1Department of Obstetrics and Gynecology, Ambo General Hospital, Ambo, Ethiopia; 2Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, EthiopiaCorrespondence: Gizachew Abdissa Bulto Email gizachab@yahoo.comBackground: The World Health Organization recommends a caesarean section (CS) rate at health facilities from 10 to 15%, but the rate is higher at most of the institutions in different countries, including Ethiopia resulting in negative health-related and economic consequences. Vaginal birth after caesarean section (VBAC) is a safe and appropriate choice to decrease the rate of CS. Though the success rate is 60– 80%, the number of mothers who experience the trial of labor is decreasing and the overall CS rate is rising. There is also limited information on determinants of successful VBAC in Ethiopia. Therefore, the study aimed to identify determinants of successful VBAC at public hospitals in Ambo town.Methods: A Facility-based retrospective unmatched case-control study was employed at public hospitals in Ambo town, Ethiopia, from June 1 to July 1, 2020. A systematic random sampling technique was used to select cases (n=74) and controls (n=221). The data were collected using a structured questionnaire and it was filled IN by reviewing the client’s medical record. The data were entered into Epi Info and exported to SPSS for analysis. Bivariate and multivariable logistic regression analysis was carried out for data analysis. Finally, statistical significance was determined based on the odds ratio with its 95% confidence interval and a p-value of < 0.05.Results: Mothers whose age was less than 25 years and 25– 29 years (AOR: 8.88; 95% CI 3.03, 26.03) and (AOR: 5.37; 95% CI 2.28, 12.66), respectively, mothers who had a history of previous successful VBAC (AOR: 3.01; 95% CI 1.47, 6.13), had a history of previous spontaneous vaginal delivery (AOR: 3.85; 95% CI 1.84, 8.05) and cervical dilation ≥ 4cm at admission (AOR: 2.05: 95% CI 1.14, 3.67) were independent determinants of successful VBAC.Conclusion: The study identified that past and present obstetric conditions played a significant role in the success of VBAC. Therefore, health workers have to consider those predictors while counselling and choosing mothers for trial of labor after caesarean section (TOLAC).Keywords: determinants, vaginal birth after caesarean section, Ambo town

Abstract Background For most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC). Methods All patients who gave birth at Northwest Women’s and Children’s Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model. Results A total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI

Background: The mode of delivery of a parturient is influenced by previous caesarean section (CS) scar. Objective: The objective of the study is to evaluate the pregnancy outcomes of a parturient with one previous caesarean delivery that was managed in Mile Four hospital, Abakaliki, Nigeria. Materials and Methods: A 5-year retrospective study of women with one previous CS who delivered in Mile Four hospital between January 2011 and December 2015 was done. IBM SPSS version 20 was used for data analysis, and data were represented using frequency tables, charts, and Chi-square. The level of significance was set at an alpha level of 0.05. Results: Three hundred and twenty-two (322) women with one previous CS were selected for a trial of labor after A C/S (TOLAC). More than half of the women (53.1%) had successful TOLAC while 46.9% had a repeat CS. Of the 53.1% of women who had a successful TOLAC, One hundred and forty-one patients had spontaneous vertex delivery. Seventeen women (9.9%) on the TOLAC arm had a ruptured uterus, while seven patients (4.6%) failed the TOLAC group had uterine dehiscence. Haemorrhage was the most common maternal complication. Severe asphyxia and perinatal death were present in 5.9% and 5.3% of neonates on TOLAC arm, respectively. Conclusion: Trial of labour after a CS can result in an excellent outcome in a well-selected patient. The success rate of 53.1% in our study is encouraging. However, adequate intrapartum monitoring is recommended to reduce maternal and fetal complications.

Abstract Objective To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. Methods A descriptive epidemiological study using data from secondary birth records fromthe 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. Results The overall rate of CSwas 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. Conclusion Over half of the births in Brazil were cesarean sections. The Midwest had the highestCS rates,while theNorth had the lowest. The largestobstetric 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.

Background: High rate of repeat cesarean section and its complications are the results of cesarean tsunami in the last two decades in Iran. Vaginal birth after cesarean (VBAC) is an important alternative for repeat cesarean. However, the rate of VBAC in Iran is very low subject to some organizational and individual barriers is very low. This study explored the clinician’s and women's perceptions of individual barriers to achieve VBAC. Methods: In this conventional content analysis, 28 semi-structured interviews and one focus group discussion was conducted with health care providers including gynecologists, midwives and family physicians as well as prior cesarean section mothers attended one of the women's hospitals in Mashhad, Iran in 2017. Participants were selected through purposive sampling considering the strategy of maximum variation. Data were analyzed according to Graneheim and Lundman (2004) method using MAXQDA.10 software. Results: The theme of “obstacles to acceptance and committed actions” emerged from two categories of “psychological barriers” and “operational barriers". Psychological barriers included 'sense of danger”, “financial displeasure" and "negative attitude"; whereas, operational barriers consisted of 'barriers to decision making' and 'indolence'. Conclusion: Improving women's attitude via maternity care promotion, creating supportive environment, informing mothers about choice of birth mode and empowering them in shared decision making could influence women's VBAC request. Also organizing VBAC care team and creating motivations in medical team and hospital directors through reporting of research project outcomes on safety and benefits of VBAC could affect the VBAC rate.

Background: Vaginal birth is a safe mode of childbirth for the majority of women after cesarean section (CS). However, data show that women who have undergone a CS are more likely to have an elective CS (ECS) than a vaginal birth after CS (VBAC) in many areas of the world. Aim: This study aimed to review the literature about women's mode of birth preferences and attitudes and the underlying reasons for, and factors associated with, their preferences. Methods: This is narrative literature review. PubMed/MEDLINE and Scopus databases were searched, limiting the results to non‐interventional studies published between 1990 and 2020. Twenty‐one articles were included in the analysis. Results: The review found 34 different factors that influence women's preferences. Five factors influenced both VBAC and ECS preference, depending on the study. The most common factors having a dualistic effect on preference were: medical staff recommendation, doctor's opinion, and fear of pain. The most common factors were: desire to experience natural childbirth, faster/easier recovery, support from doctor's, and midwife's opinion. Among the factors influencing the preference for ECS, two were particularly prominent: predictability, controllability and comfortability of CS and the belief that CS is safer for the baby and/or mother. Conclusions: Our review showed that there are a variety of factors that influence women's preference for the mode of delivery after CS. Some of these have a dualistic effect according to the study. The key to making an informed decision regarding the mode of delivery is communication with medical professionals. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric anal sphincter injuries (OASI) are severe complications that can cause considerable short- and long-term morbidity. Austria, Canada, Norway, and Sweden have similar socio-economic characteristics, and all four countries have access to national birth registers. In this study, we hypothesized that the incidence of OASI should be very similar for different obstetric scenarios in these four countries. Therefore, the aim was to compare the incidence of OASI in these four countries in primiparous women, with spontaneous or instrumental delivery (vacuum or forceps), and in women with a first vaginal birth after cesarean section (VBAC).Material and Methods: Aggregated data on 1 933 930 vaginally delivered primiparous women and women with VBAC were retrieved from the birth registers gathered in Austria, Canada, Norway, and Sweden. The annual rate of OASI (ICD-10 codes O70.2-O70.3) was presented as the percentage of women with a spontaneous delivery, vacuum or forceps delivery, and a VBAC during the period 2004-2016.Results: The incidence of OASI varied considerably between countries and over time. Canada and Sweden had the highest rates, and Austria and Norway the lowest. In Norway, the rate of OASI decreased consistently for all types of deliveries after introducing a perineal protection program in 2004 (p < 0.001). During vacuum delivery, the incidence of OASI varied between countries from 4.1% to 15.5% across the study period. In Canada and Norway, the rate of OASI after a forceps delivery was similar in 2004 at ~20% and with differing trajectories to 24.3% (β 0.49) and 6.2% (β -1.15) (trend, all p < 0.001) in 2016.Conclusions: This comparative register study suggests that there may be considerable potential for lowering the incidence of OASI. The perineal protection program implemented by Norway has been successful. Each country should critically, without prejudice, analyze their current clinical practices and rate of OASI and consider the best preventive strategy. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence for the relationship between maternal and perinatal factors and the success of vaginal birth after cesarean section (VBAC) is conflicting. We aimed to systematically analyze published data on maternal and fetal factors for successful VBAC. Methods A comprehensive search of Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature, from each database’s inception to March 16, 2018. Observational studies, identifying women with a trial of labor after one previous low-transverse cesarean section were included. Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. Results We included 94 eligible observational studies (239,006 pregnant women with 163,502 VBAC). Factors were associated with successful VBAC with the following odds ratios (OR;95%CI): age (0.92;0.86–0.98), obesity (0.50;0.39–0.64), diabetes (0.50;0.42–0.60), hypertensive disorders complicating pregnancy (HDCP) (0.54;0.44–0.67), Bishop score (3.77;2.17–6.53), labor induction (0.58;0.50–0.67), macrosomia (0.56;0.50–0.64), white race (1.39;1.26–1.54), previous vaginal birth before cesarean section (3.14;2.62–3.77), previous VBAC (4.71;4.33–5.12), the indications for the previous cesarean section (cephalopelvic disproportion (0.54;0.36–0.80), dystocia or failure to progress (0.54;0.41–0.70), failed induction (0.56;0.37–0.85), and fetal malpresentation (1.66;1.38–2.01)). Adjusted ORs were similar. Conclusions Diabetes, HDCP, Bishop score, labor induction, macrosomia, age, obesity, previous vaginal birth, and the indications for the previous CS should be considered as the factors affecting the success of VBAC.

George Linn,1,2 Yung-hsiang Ying,3 Koyin Chang21Show Chwan Memorial Hospital, Changhua, Taiwan; 2Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan; 3Department of Business Administration, College of Management, National Taiwan Normal University, Taipei, TaiwanBackground: Babies are sometimes delivered by cesarean section (CS) to women eligible for trial of labor after a cesarean (TOLAC) due to a fear of complications during the delivery process. This view is especially widespread in Taiwan, as evidenced by the extremely low rate (

Background: For most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC).Methods: All patients who gave birth at Northwest Women's and Children's Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model.Results: A total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI < 24 kg/m2, cervical score ≥ 5, a history of previous vaginal delivery and neonatal birthweight < 3300 g were associated with the success of TOLAC. The area under the receiver operating characteristic curve in the prediction and validation models was 0.815 (95% CI: 0.762-0.854) and 0.730 (95% CI: 0.652-0.808), respectively, indicating that the nomogram prediction model had medium discriminative power.Conclusion: The TOLAC was useful to reducing the cesarean section rate. Being primiparous, not overweight or obese, having a cervical score ≥ 5, a history of previous vaginal delivery or neonatal birthweight < 3300 g were protective indicators. In this study, the validated model had an approving predictive ability. [ABSTRACT FROM AUTHOR]

Few studies have examined the relationship between pelvic size and the success or failure of trial of labor after cesarean delivery (TOLAC). Here we aimed to determine whether pelvic size and morphological data obtained from radiography contribute to the first successful TOLAC. This retrospective single-center observational study enrolled pregnant women who underwent TOLAC between 2010 and 2021. The results of X-ray pelvimetry data, including obstetric conjugate (OC), transverse diameter of the pelvic inlet (TD), anteroposterior diameter of the pelvic inlet (APD), shape of the pelvic inlet, and other obstetrical clinical data, were compared between the success and failure groups. Seventy-five patients in successful group after excluding 35 patients with previous successful TOLAC, and 21 patients in failure group were eligible. The failure group had a higher rate of previous cesarean sections due to failed labor trials (p = 0.042) and heavier newborns (p = 0.014). OC, TD, and APD on X-ray pelvimetry did not differ significantly between the two groups nor did the shape of the pelvic inlet affect the success rate for TOLAC. The generalized linear model identified a history of failed trials of labor as a significant predictor of failed TOLAC (odds ratio, 0.26; 95% confidence interval 0.071-0.923; p = 0.037), whereas no pelvimetric parameters were found. Pelvic size and morphological findings have no discernible impact on the outcomes of TOLAC. The universal application of X-ray pelvimetry in all women attempting TOLAC may not have significant clinical relevance.

Background Isthmocele or a scar defect is a relatively common consequence of cesarean section resulting in menstrual disturbances and infertility and may compromise the myometrial integrity of the uterus in women contemplating subsequent vaginal birth. Several preventive measures have been suggested, including the modification of surgical techniques used for the closure of the uterine incision. The current study aimed to compare the incidence of isthmocele and assess residual myometrial thickness in women who underwent single versus parallel layered closure to approximate the endo-myometrial layer during cesarean section. Methodology This retrospective study evaluated data of women undergoing their first cesarean section under elective conditions (n = 497) where the uterine incision was closed using a single (n = 295) or a parallel layer (n = 202) technique. Patients were evaluated twice, at 3-6 months and 18 months postpartum, with a transvaginal ultrasound noting the presence or absence of an isthmocele and measurement of the residual myometrial thickness. Results Regardless of the closure technique, 64 (12.9%) women had an ultrasound-diagnosed isthmocele. Significantly fewer patients in the parallel-layer closure group presented with an isthmocele both at 3-6 (13.6 vs. 6.9%; p = 0.019) and 18 months (16.3 vs. 7.8%; p = 0.009) postpartum. Residual myometrium was significantly thicker in the parallel-layer closure group (8.0 vs. 13.2 mm at 3-6 months postpartum; p = 0.000 and 7.2 vs. 12.3 mm at 18 months postpartum; p = 0.004). For all patients, a retroverted position of the uterus at 3-6 months follow-up examination significantly increased the frequency of isthmocele (36/395 (9.1%) with an anteverted uterus and 18/102 (17.6%) with a retroverted uterus; p = 0.002). In patients with a single-layer closure, a retroverted uterus at the 3-6-month follow-up was associated with an isthmocele in 29.5% (18/61) of patients, while no isthmocele was recorded when the uterus was retroverted in the parallel-layer closure group (0/41) (p = 0.001). At 18 months postpartum, of the 64 patients with an isthmocele, 26 (40.6%) presented with abnormal uterine bleeding mainly in the form of postmenstrual spotting. Of the 26 patients with abnormal bleeding, 23 were in the single-layer and three were in the parallel-layer closure group. Conclusions The parallel-layer closure when compared to a single-layer closure of the uterine incision in patients undergoing primary cesarean section decreased the incidence of isthmocele formation and increased residual myometrial thickness. More patients in the single-layer closure group had menstrual cycle disturbances at 18 months postpartum., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alper et al.)

Introduction:The measurement of the lower uterine segment (LUS) thickness before labor predicts hazardous complications of vaginal birth after cesarean section (VBAC). Vaginal birth after cesarean is one of the most effective methods used to reduce the incidence of cesarean section. Therefore, this study was carried out to evaluate the diagnostic value of sonographic measurement of lower uterine segment (LUS) thickness in uterine rupture during cesarean section and its associated factors in women with and without previous cesarean section. Methods: This prospective cohort study was conducted among 168 pregnant women in two groups of with and without the history of cesarean section (84 individuals per group) referred to Ardabil Alavi Hospital, Ardabil, Iran, in 2016. The thickness of the LUS was determined through transabdominal ultrasonography between the gestational ages of 36 to 40 weeks. At the time of cesarean section, the thickness of the women’s LUS and newborns’ weight and Apgar score were measured and recorded. Additionally, uterine rupture was recorded in patients with the past history of cesarean section. Moreover, the relationship between the LUS thickness and maternal age, gestational age, the indication for previous cesarean section, interdelivery interval, embryo weight, and abnormalities of erythrocyte were determined. Data analysis was performed using descriptive statistics and t-test in SPSS software, version 16. Results: According to the pre-operative assessments, the LUS thickness in the women with and without the history of cesarean section were 4.26±1.99 mm and 6.11±1.6 mm, respectively (P˂0.001). According to the findings obtained from sonography before and during the operation, there was a significant difference between the groups in terms of LUS thickness (P0.05). Based on the results, the LUS thickness of 1.8 mm was considered as the critical cutoff value for predicting uterine rupture. Conclusion: The measurement ofLUS thickness is a non-invasive technique to predict the uterine rupture, which leads to increased rate of VBAC.

Background: One of the primary reasons for an increase in cesarean sections is obstetricians' uncertainty about labor trial safety following a previous cesarean section. The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%. However, to the best of our knowledge, there is a scarcity of information on the determinants of vaginal birth after cesarean delivery in the study area. As a result, the purpose of this study was to identify predictors of successful vaginal birth after cesarean delivery in public hospitals in Eastern Ethiopia. Methods: A nested case–control study design was used within a prospective follow-up study conducted from June to October 2020. A total of 220 women who tried vaginal birth after cesarean delivery was included, 110 cases and 110 controls. Cases were women with one previous cesarean section scar and successfully proceed with vaginal delivery. The controls were those with an earlier cesarean section scar and delivered by emergency cesarean section after trial of labor. A pre-tested structured questionnaire was used to gather the information. Multiple logistic regression is used to identify the determinants for the success of vaginal birth after cesarean section; odds ratio with its 95% CI are used to report the findings. Results: We found that living in rural areas (AOR = 2.28; 95% CI (1.85, 12.41)), having a current antenatal care follow-up (AOR = 3.20; 95% CI (1.15, 8.87)) and partograph monitoring of labor (AOR = 4.26; 95% CI (1.90, 9.57)) had a positive association with successful vaginal birth after cesarean section. In contrast, the presence of meconium-stained amniotic liquor (AOR = 0.10; 95% CI (0.01, 0.75)) and history of stillbirth (AOR = 0.07; 95% CI (0.02, 0.53)) reducing the chance of success of the trial. Conclusion: Past obstetric history, such as stillbirth, history of labor trial after primary cesarean section, and prior vaginal birth, were significant predictors for achieving vaginal birth after cesarean section. Antenatal care visit, and partograph follow-up were the current obstetric characteristics positively associated with the trial of labor. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of uterine rupture after one successful vaginal birth after caesarean section. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynecology of Nishtar Hospital Multan. Period: 12-May-2017 to 11-May-2018. Material & Methods: Total number of 135 patients of 16-45 years with singleton pregnancies were admitted for 2nd Vagina Birth after cesarean Section at gestational age ≥ 28 weeks of gestation. Data in shape of parity, gestational age and BMI was taken. These patients were assessed for frequency of uterine rupture after one successful vaginal birth after caesarean section. Data was analyzed with statistical analysis program (SPSS version 21). Frequency and percentage was calculated for qualitative variables like parity and uterine rupture. Mean ± SD was calculated for quantitative variables like age, BMI and gestational age. Results: Mean age of patients was 29.88+5.34 years. Mean body mass index (BMI) of study patients was 25.17+4.88 kg/m². Mean gestational age at the time of delivery was 39.01+2.54 weeks. Uterine rupture after vaginal birth occurred in 2 (1.48%) patients. There was no association of gestational age, parity and gestational age with the frequency of uterine rupture. Conclusion: Women with prior successful VBAC are at low risk of maternal and neonatal complications during subsequent trail of VBAC with lower risk of uterine rupture and perinatal complications. [ABSTRACT FROM AUTHOR]

Background: In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China. Methods: This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression. Results: Data showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ2 = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07–5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18–0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ2 = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00–1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05–1.11; P = 0.00) were significantly associated with fetal distress in VBAC. Conclusions: The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.

Objective: The trend of increasing cesarean section rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements. In this study, we try to reveal the world trend in VBAC and our experience of a 10-year period in a medical center in northern Taiwan. Materials and methods: This is a retrospective study of all women who underwent elective repeat cesarean delivery or trial of labor after cesarean (TOLAC) following primary cesarean delivery by a general obstetrician–gynecologist in the Tamshui Branch of MacKay Memorial Hospital (Taipei, Taiwan) between 2006 and 2015. We excluded cases of preterm labor, two or more cesarean deliveries, and major maternal diseases. We compared the characteristics and outcomes between these groups. Results: We included 400 women with subsequent pregnancies who underwent elective repeat cesarean delivery or TOLAC during the study period. Among the study population, 112 women were excluded and 11 underwent repeat VBAC. A total of 204 (73.65%) cases underwent elective repeat cesarean delivery and 73 (26.35%) chose TOLAC. The rate of successful VBAC among the women who chose TOLAC was 84.93%. Conclusion: With respect to maternal and fetal safety, and success rates and adverse effects of VBAC, the results of this study are promising and compatible with the global data. It shows that a trial of VBAC can be offered to pregnant women without contraindications with high success rates.

Objective: To study the association between the level of Cesarean hysterotomy and the presence of large uterine scar defects 6-9 months after delivery.Methods: This was a two-center, randomized, single-blind trial of a surgical procedure with masked assessment of the principal outcome under study. Women without a history of Cesarean section (CS) who underwent emergency CS at cervical dilatation ≥ 5 cm were randomized to high or low incision. Hysterotomy was performed 2 cm above and 2 cm below the plica vesicouterina in the high and low incision groups, respectively. Women were examined using saline contrast sonohysterography to assess the appearance of the hysterotomy scar 6-9 months after delivery. The main outcome was presence of a large scar defect, defined as the remaining myometrial thickness over the defect being ≤ 2.5 mm. Secondary outcomes were perinatal outcome, operative complications within 8 weeks after delivery and long-term outcome in a subsequent pregnancy.Results: Of 122 patients enrolled in the trial, 114 were assessed by ultrasound examination, of whom 55 were randomized to high and 59 to low CS incision. Large scar defects were seen in four (7%) women in the high-incision group and in 24 (41%) in the low-incision group (P < 0.001; odds ratio, 8.7 (95% CI, 2.8-27.4)). There were no differences in operative complications and perinatal outcomes between the two groups. The median follow-up time was 4 years and 7 months, during which 56 (49%) women had a subsequent pregnancy. No significant differences were observed in the rate of complications in subsequent pregnancy and delivery between women who had low and those who had high incision at the index CS.Conclusion: Low Cesarean hysterotomy level in women in advanced labor is associated with higher incidence of large scar defects detected by transvaginal ultrasound examination 6-9 months after delivery. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background: A successful trial of labor after cesarean (TOLAC) is linked with the best maternal/neonatal outcomes and is more cost-effective than elective repeat cesarean section (ERCS). Predictive models of vaginal birth after cesarean (VBAC) have been established worldwide to improve the success rate of TOLAC., Objective: To validate a VBAC prediction model (the updated Grobman's predictive model without ethnicity) and identify whether mid-trimester cervical lengths (MCL) improve the prediction of VBAC among Chinese women undergoing a TOLAC., Methods: In this retrospective cohort study, the inclusion criteria were a previous history of cesarean delivery (CD) as well as a singleton gestation in the vertex position with routine CL measurements between 20 and 24 weeks and the experience of a TOLAC. MCL as well as identifiable characteristics in early prenatal care that have been used in updated Grobman's predictive model (maternal age, height, pre-pregnancy weight, vaginal delivery history, VBAC history, arrest disorder in previous CD, and treated chronic hypertension) were obtained from the medical records. Associations of maternal characteristics and MCL with VBAC were evaluated using multivariate logistic regression. Two multivariable regression models with and without MCL as one of the risk factors were established and their predictive accuracy for VBAC was critically compared based on receiver-operating characteristic (ROC) curves., Results: This study involved 409 women, among which, 347 (84.8%) achieved a VBAC. The mean MCL was significantly shorter in women who had a successful VBAC than in those who required an intrapartum CD (4.16±0.49 cm vs. 4.35±0.46 cm, P=0.007). Multivariable logistic regression revealed that a longer MCL (cm) was significantly related to a lower success rate of TOLAC [adjusted odds ratio (aOR), 0.48; 95% confidence interval (CI), 0.26-0.88]. The areas under the ROCs of Grobman's model with and without MCL as one of the risk factors were 0.785 (95% CI, 0.725-0.844) and 0.774 (95% CI, 0.710-0.837), respectively, but not significantly different (Z = -0.968, P = 0.333)., Conclusions: We first evaluated the efficiency of the updated Grobman's model (without race and ethnicity) in the Chinese population. The area under the curve is relatively high, indicating that the model can be used efficiently in China. The shorter MCL was associated with a greater chance of VBAC and MCL was the independent factor from the factors of Grobman's model. However, the predictive capacity of the modified model by adding MCL as one of the risk factors did not improve significantly., Competing Interests: Declaration of Competing Interest The authors reported no declarations of interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: The purpose of this study is to compare the success rate of vaginal birth after cesarean (VBAC) in spontaneous and induced labor. Design: This is an 8-year retrospective comparative study. Setting: University hospital. Population: Five hundred and ninety-four women who had one previous lower segment cesarean delivery. Materials and Methods: This is a retrospective study of all women, who had lower segment cesarean section, admitted for trial of labor between April 2010 and November 2016. Five hundred and sixty-seven women who elected to have trial of labor after one previous cesarean were included in the study, of these 477 (84.13%) had spontaneous onset of labor (control group) and 90 (15.87%) had induction of labor (IOL) (study group). Two hundred and seventy-seven women had no previous vaginal delivery, and 297 had one previous vaginal delivery. Results: We compared the success rates of VBAC in women who had IOL with those who came with spontaneous labor. The rate of vaginal delivery after CS (VBAC) was 50.0% and 66.6% in the study and control groups, respectively. There was a significant increase in the rate of cesarean delivery due to fetal distress in the study group (P = 0.016). There were no cases of uterine rupture in the control group and one case in the study group. Patients who had spontaneous labor and at least one previous vaginal delivery have higher success rate of vaginal delivery. Conclusion: Women with one previous CS, who undergo IOL, have lower success rates of vaginal delivery compared with those who presented in spontaneous labor. They also have higher risk of CS delivery due to fetal distress. Previous normal vaginal delivery increases the success rate of VBAC. [ABSTRACT FROM AUTHOR]

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When gross hematuria occurs after a successful vaginal birth after cesarean section, bladder injury should be suspected. We report a postpartum patient who experienced progressively worsening abdominal pain a few hours after delivery and was found to have a simultaneous bladder and uterine rupture, which were successfully repaired via a laparoscopic approach. This case highlights a laparoscopic approach to repairing both defects in the immediate postpartum period. [ABSTRACT FROM AUTHOR]

INTRODUCTION: l'incidence des utérus cicatriciels est en nette augmentation ces dernières décennies. L'obstétricien est alors fréquemment sollicité à décider du mode d'accouchement le plus approprié à la mère et son fétus. L'objectif de cette étude est de décrire la pratique obstétricale d'un accouchement sur utérus unicicatriciel au sein de notre service et d'identifier les facteurs significativement associés à l'échec de la tentative de voie basse après césarienne. METHODES: nous avons mené notre étude sur une population de femmes porteuses d'un utérus unicicatriciel. Elle était rétrospective longitudinale de type descriptif et analytique. Nous l'avons réalisée sur une période de deux ans et trois mois du 1er Janvier 2012 au 31 Mars 2014 durant laquelle nous avons colligé 423 dossiers de patientes qui ont eu une tentative de voie basse au centre de maternité et de néonatologie de Bizerte. RESULTATS: le taux de tentatives de voie basse après césarienne était de 47%. Les taux de succès et d'échec de ces tentatives étaient respectivement de 82,7% et 17,3%. Les principaux facteurs de mauvais pronostic de la tentative de voie basse après césarienne étaient: l'absence d'antécédent d'accouchement par voie basse (p=0,005), une indication de la césarienne antérieure pour stagnation de la dilatation ou défaut d'engagement (p respectifs de 0,049 et 0,002), un terme d'accouchement ? 40 SA (p=0,046), une parité 3 (p=0,75.10-4), un score de Bishop 6 au début du travail (p=0,23.10-47), une phase active de durée? 6h (p=0,002), un travail de durée 8h (p=0,0031) et la survenue d'une anomalie du RCF au cours du travail (p=0,144.10-9). Nous avons observé sept cas de rupture utérine soit un taux de 1,7%. Nous n'avons observé aucun cas de mortalité maternelle. La morbidité maternelle globale était de 9,5%. La différence des taux de complications maternelles entre les deux groupes échec et succès de la tentative de voie basse après césarienne n'était pas statistiquement significative.

Objective: To determine predictive factors for vaginal birth after cesarean section (VBAC). Methods: A retrospective cohort study of all women with singleton pregnancies and a prior single low transverse cesarean section (CS) who attempted vaginal delivery in a tertiary hospital (2010–2014). Pregnancy outcome of women with VBAC was compared to those who failed vaginal delivery. Sub-analysis for women with no prior vaginal deliveries was performed. Pregnancies with non-cephalic presentation, estimated fetal weight >4000 g and any contraindications for vaginal delivery were excluded. Results: Of the 40 714 deliveries, 1767 women met inclusion criteria. Among them 1563 (88.5%) had a VBAC and 204 (11.5%) failed. There was no significant difference between the groups regarding maternal age, comorbidities and pregnancy complications. Predictors for VBAC were (odds ratio, 95% confidence interval) interval from prior CS (1.13, 1.04–1.22,p=0.004), previous VBAC (2.77, 1.60–4.78,p < 0.001), prior vaginal delivery prior to the CS (3.05, 1.73–5.39,p < 0.001) and induction of labor (0.62, 0.40–0.97,p = 0.03). For women with no prior vaginal birth, only birthweight was associated with VBAC (0.99, 0.99–1.00,p = 0.02). Conclusion: While different variables may influence the rate of VBAC, the predictive ability of VBAC for women with no previous vaginal deliveries remains poor. [ABSTRACT FROM PUBLISHER]

Objective: To study the change in frequency of cesarean section, repeat cesarean section and the indications for repeated cesarean section after 10 years at a tertiary care center in Karachi. Methods: This study was conducted in the department of Obstetrics and Gynaecology, unit 1, Abbasi Shaheed Hospital. This retrospective analysis used departmental records to compare cesarean section rates for 2 years, 10 years apart. i.e. 2002 and 2012.The study thus spans a twelve month period extending from 1st January 2002 to 31st December 2002 and twelve months from 1st January 2012 to 31st December 2012.Using data from both study periods women who had successful vaginal birth after cesarean and women who had a repeat cesarean section were determined. Additionally, the rate of repeat cesarean section and indications for repeat cesarean section were analyzed for each study period. Results: In year 2002, 411 out of 1425 total births had cesarean. The cesarean section rate was 28.8%, whereas in 2012, the cesarean section rate was 44% (615 out of 1212 total births). Ninety-two out of 411(22.38%) in 2002 had prior cesarean section, whereas 192 out of 615 (44%) had prior cesarean section in 2012. In those with previous cesarean section, successful vaginal birth after Cesarean section was 38% in 2002 and 21.88% in 2012. The leading indications for repeat cesarean were non-progress of labour, fetal distress and scar tenderness. Maternal wish contributed to 4.6% repeat cesareans in 2012, whereas only 1.7% of study population desired repeat cesarean section in 2002. Conclusion: Cesarean rates are on the rise in this tertiary care center of Karachi. As compared to ten years back, the rate has risen from 28.8% to 44%. The overall high section rate at this center may be accounted for by the fact that it deals with high risk Obstetrics and referred cases from Karachi and the province of Sindh. However, 16% rise in overall cesarean is quite dramatic. [ABSTRACT FROM AUTHOR]

Objective: Primarily, to assess the performance of three statistical models in predicting successful vaginal birth in patients attempting a trial of labour after one previous lower segment caesarean section (TOLAC). The statistically most reliable models were subsequently subjected to validation testing in a local antenatal population.Study Design: A retrospective observational study was performed with study data collected from the Northern Ireland Maternity Service Database (NIMATs). The study population included all women that underwent a TOLAC (n=385) from 2010 to 2012 in a regional UK obstetric unit. Data was collected from the Northern Ireland Maternity Service Database (NIMATs). Area under the curve (AUC) and correlation analysis was performed.Results: Of the three prediction models evaluated, AUC calculations for the Smith et al., Grobman et al. and Troyer and Parisi Models were 0.74, 0.72 and 0.65, respectively. Using the Smith et al. model, 52% of women had a low risk of caesarean section (CS) (predicted VBAC >72%) and 20% had a high risk of CS (predicted VBAC <60%), of whom 20% and 63% had delivery by CS. The fit between observed and predicted outcome in this study cohort using the Smith et al. and Grobman et al. models were greatest (Chi-square test, p=0.228 and 0.904), validating both within the population.Conclusion: The Smith et al. and Grobman et al. models could potentially be utilized within the UK to provide women with an informed choice when deciding on mode of delivery after a previous CS. [ABSTRACT FROM AUTHOR]

Study Objective To determine the rate of elective repeat cesarean delivery (CD), vaginal birth after cesarean (VBAC) attempt, and VBAC success in adolescent mothers presenting for delivery of a second child after a prior CD compared to their adult counterparts. Design Retrospective cohort study analyzing data from the Consortium on Safe Labor Database which includes data for 228,668 deliveries from 2002 to 2008. Setting 19 hospitals within 12 institutions in the United States. Participants 10,791 women age ≤ 35 (428 adolescents, age ≤ 19 and 10,363 adults age 20-35) with history of prior CD presenting for delivery of a second child. Methods The database was accessed for information on patient characteristics, prenatal comorbidities, and delivery data. Rates of repeat CD, VBAC attempt, and VBAC success were calculated. Multiple logistic regression was applied to identify predictors of VBAC success. Results Adolescents had a lower overall repeat CD rate and higher VBAC attempt rate compared to adults (80.61% vs 85.32%, P = .0072; 40.42% vs 30.09%, P < .0001 respectively). VBAC success was similar between adolescents and adults (47.98% vs 48.78% P = .8368). Delivery at a teaching hospital and greater gestational age were predictive of VBAC success. Gestational diabetes mellitus, induction of labor, and higher maternal body mass index were predictive of VBAC failure. Adolescence was not an independent predictor of VBAC outcome. Conclusions Adolescents are more likely to attempt VBAC and are likely to be as successful as their adult counterparts. Adolescents should be encouraged to attempt a trial of labor after prior CD when appropriate to lower the risks of lifelong maternal morbidity from numerous repeat CDs. [ABSTRACT FROM AUTHOR]