List of Abbreviations
BP | blood pressure |
|---|---|
TOLAC | vaginal birth after cesarean |
VD | vaginal delivery |
CS | cesarean section |
Cx | cervix |
LA | labor activity |
UR | uterine rupture |
HSG | hysterosalpingography |
CI | confidence interval |
CTG | cardiotocography |
MRI | magnetic resonance imaging |
OR | odds ratio |
US | ultrasound examination |
RR | respiratory rate |
EA | epidural anesthesia |
ACOG | The American College of Obstetricians and Gynecologists |
SOGC | Society of Obstetricians and Gynecologists of Canada |
RANZCOG | Royal Australian and New Zealand College of Obstetricians and Gynecologists |
VBAC | Vaginal Birth After Cesarean |
Terms and Definitions
Vaginal birth with a uterine scar is spontaneous delivery through the natural birth canal in a patient with a uterine scar following surgical intervention.
Scheduled/planned repeat CS in the presence of a uterine scar is delivery by elective CS prior to the onset of labor and rupture of fetal membranes in the presence of a uterine scar.
Trial of labor after cesarean (TOLAC) is a planned attempt at vaginal delivery in women with a uterine scar from previous surgery with the aim of achieving a successful birth.
Complete uterine rupture is a uterine rupture extending into the abdominal cavity (damage to the myometrium and visceral peritoneum) or loss of myometrial integrity with extension of the rupture into the urinary bladder or round ligament of the uterus, with or without displacement of fetal parts into the maternal abdominal cavity.
Incomplete uterine rupture is a loss of myometrial integrity not extending into the abdominal cavity, without damage to the visceral peritoneum, intact amniotic sac, and without extrusion of fetal parts into the maternal abdominal cavity.
Niche (isthmocele) is a defect of the uterine muscular wall of various shapes with a depth of ≥2 mm.
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
Postoperative uterine scar requiring maternal medical care during pregnancy, labor, and the postpartum period is a condition complicating the course of pregnancy, labor, and the postpartum period associated with the presence of a uterine scar following one or more previous cesarean sections or other uterine surgeries [1–3].
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
A uterine scar develops as a result of the following surgical interventions on the uterus:
History of cesarean section delivery (78–84%):
- One previous cesarean section (86–88%).
- Two previous cesarean sections (10–13%).
- Three or more previous cesarean sections (1%).
History of myomectomy (10–12%).
Division of uterine septum (4–5%).
Surgical interventions associated with uterine malformations (up to 1%).
There are two theories of uterine rupture: the mechanical theory, according to which ruptures occur due to a spatial mismatch between the fetal presenting part and the maternal pelvis; and the histopathic theory, according to which the main cause of ruptures is deep histopathic changes in the myometrium resulting from atrophic, dystrophic, and inflammatory processes in the myometrium. The main causes of histopathic uterine rupture are a uterine scar following various surgeries, as well as multiple intrauterine interventions.
To date, it is unknown what percentage of women with a uterine scar after a cesarean section can be selected for a trial of vaginal birth out of the entire population of women with a uterine scar. According to national statistics from various countries, 13 to 30–50% of women with a uterine scar can be selected for a trial of vaginal birth [1, 4–6].
1.3 Epidemiology of the Disease or Condition
The global rate of operative delivery has increased by 21% over the past 15 years and continues to rise steadily [7]. Despite WHO and FIGO recommendations on the optimal CS rate, the rate of CS delivery in European countries ranges from 16.1% to 56.9%, and exceeds 60–70% in Asian and Latin American countries [8]. High rates of operative delivery lead to an increase in the number of women of reproductive age with a uterine scar [9]. In the Russian Federation, this indicator is also increasing, reaching 31.8% by 2023.
In the Russian Federation, the rate of vaginal birth in patients with a uterine scar does not exceed 1.5% [10]. According to various authors, the success rate of vaginal birth with a uterine scar ranges from 50% to 85% [3]. The average success rate of vaginal birth with a scar after a single CS is 72–76% in the absence of factors that reduce the likelihood of success, and 30–50% in the presence of these factors. This indicator is calculated from the number of TOLAC attempts, but not from the total number of women with a uterine scar [11]. Maternal morbidity during a successful TOLAC attempt is low. Maternal mortality is mainly associated with uterine rupture (22–75/10,000), hemorrhage, thromboembolism, and infectious complications—the incidence of postpartum endometritis increases by 1% (289/10,000 compared to 180/10,000 with elective cesarean section) [10, 12, 13]. The risk of complications with planned cesarean section in women with a uterine scar significantly exceeds the risk with a successful trial of vaginal birth. Maternal mortality during TOLAC is 17 per 100,000 TOLAC attempts compared to 44 per 100,000 with elective cesarean section. Vaginal birth with a uterine scar can reduce the risk of neonatal respiratory diseases by 15–20% compared to elective cesarean section [14–16]. Planned CS increases the risk of thromboembolism by 3.8 times; uterine rupture in subsequent pregnancies by 42 times; abdominal pain by 2 times; and bladder injury by 36 times. There are no statistically significant differences in blood loss volume (>1000 ml); dyspareunia; or cerebral palsy.
1.4 Features of Coding the Disease or Condition
O34.2 Postoperative scar in uterus, requiring care of mother.
O75.7 Vaginal delivery following previous cesarean section.
1.5 Classification of the disease or condition
According to the integrity of the uterine scar: competent uterine scar; incompetent uterine scar. According to the location of the uterine scar: in the lower uterine segment, in the uterine body; partially in the lower segment, partially in the body (following an isthmico-corporal incision on the uterus), in the uterine fundus.
1.6 Clinical presentation of the disease or condition
Not applicable.
2. Diagnostics, medical indications and contraindications for diagnostic methods
The diagnosis of a postoperative uterine scar requiring maternal medical care is established based on a history of myomectomy (or other surgeries) involving entry into the uterine cavity, or a previous cesarean section. Competent scars are those with a thickness of 2.5 mm or more, with an absence or minimal amount of echopositive inclusions (connective tissue elements) and good vascularization.
However, according to modern data, the absence of local tenderness upon palpation of the uterine scar after cesarean section in a pregnant woman, as well as the absence of vaginal bleeding and fetal hypoxia according to CTG data, indicates scar competence and the possibility of spontaneous delivery [10, 17], which does not contradict the aforementioned document.
2.1 Complaints and Anamnesis
It is recommended to collect obstetrical and gynecological history and complaints to assess the likelihood of successful vaginal birth with a uterine scar [11, 18–24].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: Factors increasing the likelihood of successful vaginal birth include a history of vaginal delivery before or after the performed cesarean section [11, 17–20, 22–26]. Factors reducing the likelihood of successful vaginal birth with a uterine scar include indications for the previous CS: fetopelvic disproportion, labor dystocia, cervical dystocia, acute fetal hypoxia [17, 24, 27–29].
It is recommended to collect somatic history and complaints to assess the likelihood of successful vaginal birth with a uterine scar [21, 24, 27, 30–33].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Comment: Factors reducing the likelihood of successful vaginal birth with a uterine scar include maternal obesity: body mass index greater than 30 kg/m2 [24, 34–36]; diabetes mellitus [11, 36] (diabetes mellitus is not a contraindication to a trial of vaginal birth in the presence of a uterine scar [36–38]).
2.2 Physical Examination
It is recommended to assess the patient's anthropometric data to evaluate the likelihood of successful vaginal birth with a uterine scar [21, 27, 30–33].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: Factors reducing the likelihood of successful vaginal birth with a uterine scar include maternal age over 40 years [11, 27, 33, 39, 40].
It is recommended to assess the degree of cervical ripeness using the Bishop score (Appendix G1) upon admission to the hospital to evaluate the likelihood of successful vaginal birth with a uterine scar [21, 22, 27, 30–33, 41].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: A ripe cervix at the onset of labor increases the likelihood of successful vaginal birth [21, 22, 27, 30–33, 41].
It is recommended to assess complications of the current pregnancy to evaluate the likelihood of successful vaginal birth with a uterine scar [11, 41–44].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: factors that reduce the likelihood of a successful vaginal delivery with a uterine scar include: the need for labor induction, which requires cervical ripening measures; the need for labor augmentation; polyhydramnios [11]; preeclampsia [11, 42, 43]; and fetal macrosomia. Factors that do not affect the likelihood of a successful vaginal delivery include: compensated gestational diabetes without fetal macrosomia, and preterm pregnancy [11, 36, 37].
It is recommended to assess intranasal factors that influence the likelihood of a successful vaginal delivery with a uterine scar [10, 11, 24, 28, 39, 41, 45–47].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: factors increasing the probability of successful vaginal birth after caesarean section (VBAC): spontaneous onset of labor [10, 11, 45, 46]; factors decreasing it – induction of labor [41, 47–51], cephalopelvic disproportion, especially with a fetal weight greater than 4000 g [28, 44, 52, 53], labor dystocia and cervical dystocia [11, 39]
2.3 Laboratory Diagnostics
See the clinical guidelines "Single-term delivery, delivery by cesarean section".
2.4 Instrumental Diagnostics
During routine fetal ultrasound, it is not recommended to measure the thickness of the lower uterine segment before the onset of labor [51, 54, 55].
GCR ALoE 2Grade of Recommendation A (Level of Evidence – 2).
Comment: The thickness of the lower uterine segment measured before the onset of labor is not of principal significance and, in the absence of other signs of scar defect, may be omitted [51, 54, 55].
It is recommended to perform a pelvic ultrasound in the early postpartum period [3, 11, 54, 56, 57].
GCR ALoE 2Grade of Recommendation A (Level of Evidence – 2).
It is recommended to perform a uterine ultrasound on days 7–9 of the menstrual cycle in patients at risk of developing a clinically significant uterine scar niche [58].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Comment: All patients with a uterine scar after a previous cesarean section and secondary infertility should be considered at risk for developing a clinically significant scar niche [58].
2.5 Other Procedures
It is recommended to perform pathomorphological and cytological examination of the uterine cavity aspirate at the preconception stage in patients with a fluid-filled niche to diagnose chronic endometritis and urogenital infections [58].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
It is recommended to use a niche severity scoring scale at the preconception counseling stage to determine the need for surgical correction of the niche [58].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1. Non-pharmacological treatments
Not applicable.
3.2. Pharmacotherapy
It is not recommended to use prostaglandins for labor pre-induction [59–63].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: the use of prostaglandins increases the risk of uterine rupture by 2.9 times compared to patients without induction, and by 1.3 times compared to oxytocin** use [64, 65]. Pre-induction of labor using mechanical dilators is not contraindicated in pregnant women with a uterine scar after a previous cesarean section24 [11, 50, 57, 66]. Pre-induction and induction of labor must be carried out after a thorough assessment of the obstetric situation and existing risk factors: the decision to perform induction is made by a medical board. Labor induction is performed via intravenous administration of oxytocin** [10, 11, 17, 64, 65, 67].
3.3 Surgical treatments
It is recommended to perform surgical treatment in the form of hysteroscopic niche remodeling at the preconception stage for a score of 3–4 on the niche severity scale [58].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
It is recommended to perform surgical treatment in the form of metroplasty using video-endoscopic technologies at the preconception stage for a score of 5–6 on the niche severity scale [58].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
It is recommended that women who have suffered a uterine rupture during childbirth undergo a repeat scheduled cesarean section no later than 39 weeks [10–12, 56, 57, 66, 68–70].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: The absence of localized tenderness upon palpation of the uterine scar after a previous cesarean section, as well as absence of genital bleeding (during labor) and fetal hypoxia according to CTG, indicates a competent scar and the possibility of spontaneous vaginal delivery [10, 17].
It is not recommended to attempt a trial of labor with a uterine scar after a previous classical (corporeal) cesarean section [11, 17, 30, 71].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Comment: The risk of uterine rupture after a previous T- or J-shaped incision is 200–900 per 10,000 deliveries [10]. If the available information suggests a corporeal cesarean section or, more likely, a T-shaped uterine incision, the woman should be offered an elective cesarean section, as the risk of uterine rupture is 190 per 10,000 deliveries [11, 55].
It is not recommended to attempt a trial of labor with a uterine scar after previous reconstructive uterine surgery, resection of the uterine horn, hysterotomy, myomectomy with posterior wall localization and opening of the uterine cavity, or laparoscopic myomectomy without uterine closure using modern suture material [11, 20].
GPP BLOE 3Grade of Recommendation B (Level of Evidence – 3).
It is not recommended to attempt a trial of labor with a uterine scar in cases of fetal breech presentation [11, 72].
GPP ALOE 1Grade of Recommendation A (Level of Evidence – 1).
It is not recommended to attempt a trial of labor with a uterine scar when the placenta is located over the uterine scar area [11, 73, 74].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
It is not recommended to attempt a trial of labor with a uterine scar in patients with a history of more than one previous cesarean section [11, 75–79].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
It is not recommended to attempt a trial of labor with a uterine scar if the woman refuses a trial of vaginal birth after cesarean section [10, 11, 45, 70].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
It is not recommended to attempt vaginal delivery in the presence of an incompetent uterine scar, characterized by uneven critical thinning of the scar zone with signs of deformation and tenderness upon palpation with a vaginal probe [20, 68, 71, 80–82].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
For patients with a singleton pregnancy and a uterine scar in the lower uterine segment from a single previous cesarean section, with no history of uterine rupture, normal placental location away from the scar, cephalic presentation, no uneven critical thinning of the scar zone with signs of deformation and tenderness upon vaginal probe palpation, and provided the patient gives consent, spontaneous labor management is recommended [4].
GGR BLOC 1Grade of Recommendation B (Level of Evidence – 1).
To manage vaginal delivery in a patient with a uterine scar, it is recommended to ensure continuous monitoring of the mother's condition (pulse, blood pressure, consciousness, respiratory rate) and the fetus (fetal cardiotocography) in the labor and delivery room [17, 57].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Upon the onset of labor, it is recommended to insert an intravenous catheter (at least 16G). It is recommended to restrict oral fluid intake and avoid food intake during the active phase of the first stage of labor [10, 11].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
For patients with a uterine scar undergoing vaginal delivery, epidural anesthesia is recommended for pain relief if needed. Low concentrations of local anesthetics should be used during epidural anesthesia to achieve analgesia without causing a motor block [11, 83].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Comment: Epidural analgesia does not "mask" the symptoms of uterine rupture, where signs of fetal distress come to the fore [3, 57]. The advantages of epidural analgesia include the most effective pain relief compared to other methods; elimination of narcotic-induced fetal depression; no prolongation of the first stage of labor; no increased risk of cesarean section; and adequate anesthesia in case of an emergency cesarean section. Disadvantages of epidural anesthesia may include prolongation of the second stage of labor and an increased risk of instrumental vaginal delivery [57, 83].
The decision regarding the need for labor augmentation is recommended to be made based on the partograph after obtaining written consent from the parturient woman, and should be carried out exclusively via intravenous infusion of oxytocin** at a dose not exceeding 20 mIU/min [10, 11, 48, 49, 57, 84].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment: Labor augmentation is not contraindicated in pregnant women with a uterine scar after a previous cesarean section. The effectiveness of labor augmentation should be monitored using a partograph.
It is recommended to closely monitor oxytocin** infusion, maintaining a contraction frequency not exceeding 4 contractions per 10 minutes, with each lasting 45 to 60 seconds [10, 11, 48, 56, 57].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
It is recommended to perform a bimanual vaginal examination to assess the adequacy of labor progress and decide on the feasibility of continuing vaginal delivery with a uterine scar [10, 11, 49, 57, 85].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Comment: If cervical dilation in the active phase is less than 1 cm/h, amniotomy is permissible, followed by reassessment of labor progress and cervical dilation after 2 hours. If a cervical dilation rate of ≥1 cm/h is achieved, vaginal delivery should be continued. If cervical dilation remains ≤1 cm/h despite active contractions and marked fetal head molding, the delivery plan should be reconsidered in favor of a cesarean section. Weak contractions in the absence of fetopelvic disproportion and with a satisfactory maternal and fetal condition may be considered an indication for oxytocin labor augmentation [10, 11, 49, 57, 84].
It is recommended to perform abdominal delivery in the absence of effect from labor stimulation in a patient with a uterine scar if the cervical dilation rate is less than 1 cm/hour 2 hours after the start of labor stimulation [10, 47–49, 57].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
It is recommended that patients with a uterine scar undergo abdominal delivery if the cervical dilation curve reaches or crosses the action line on the partogram [10, 11, 17, 25].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Comment: Prolonged labor in a woman with a uterine scar is dangerous and increases the risk of uterine rupture [14, 50, 55, 66, 81, 86, 87].
It is recommended to revise the management strategy in favor of Cesarean section if the laboring woman refuses labor stimulation, or if there are signs of impending uterine rupture, cephalopelvic disproportion, or uterine inertia unresponsive to treatment within 2 hours [10, 11, 57].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Comment: Surgery should be initiated as early as possible, but no later than 30 minutes after the decision is made [56, 88].
It is recommended to manage the second stage of labor in accordance with standard normal labor management protocols: vertical position in the early phase; free choice of position during labor; preference for unguided (spontaneous) pushing techniques under continuous fetal monitoring and in the presence of an anesthesiologist-resuscitator in the delivery room; performance of episiotomy and vacuum-assisted vaginal delivery according to obstetric indications [89–94].
LE AQOE 3Level of Evidence A (reliability of evidence level – 3).
It is recommended to prefer active management techniques when handling the third stage of labor [93, 95–98].
GCR BLOE 2Grade of Recommendation B (Level of Evidence – 2).
Comment: active management of the third stage of labor reduces the incidence of postpartum hemorrhage caused by uterine atony by 60% [56, 99].
Following successful vaginal delivery, routine manual exploration of the postpartum uterus is not recommended in patients with a uterine scar in the absence of symptoms of rupture [3, 11].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Comment: Manual exploration of the uterine cavity is performed according to indications: hemorrhage, abdominal pain, unexplained postpartum maternal collapse, retained placental tissue, operative vaginal delivery [3, 56].
It is recommended to ensure the following for every postpartum woman: meticulous manual monitoring of uterine tone for 6 hours after delivery: every 15 minutes during the first two hours, every 30 minutes during the 3rd hour, and every 60 minutes during the subsequent 3 hours; assessment of maternal status: pulse and blood pressure; detection of potential internal hemorrhage (calculation of the shock index) and assessment of blood loss volume (volumetric method) [100–104].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Not applicable.
5. Prevention and Dispensary Observation
It is recommended to maintain an interpregnancy interval of at least 2 years and no more than 10 years [105, 106].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
6. Organization of Medical Care
Planned delivery for patients with a uterine scar is recommended to be carried out in Level 2 and Level 3 obstetric healthcare organizations. Vaginal delivery in the presence of a uterine scar after a previous Cesarean section is permissible in selected Level 2 facilities provided that: there are no indications for referral to Level 3; the necessary infrastructure and organizational conditions are in place; and there is a sufficient number of experienced staff [10, 11, 14, 30]. In the event of urgent and emergency indications for delivery via Cesarean section, the surgery is performed in the hospital where the patient is located at the time of diagnosis, provided that the necessary medical equipment and medical personnel are available to provide care to the mother and newborn [10, 11, 17].
7. Additional Information
Not applicable.
Criteria for Evaluating the Quality of Medical Care
№ | Quality criteria | Yes/No |
|---|---|---|
1 | Cervical maturity was assessed using the Bishop score to evaluate the feasibility of a trial of labor with a uterine scar | Yes/No |
2 | An intravenous catheter was inserted in the laboring woman at the onset of labor | Yes/No |
3 | Continuous cardiotocography (CTG) monitoring was performed during labor for vaginal delivery with a uterine scar | Yes/No |
4 | In the early postpartum period, pelvic ultrasound or manual exploration of the uterine cavity was performed | Yes/No |
References
Show references
Hamilton B., Martin J., Osterman M., Driscoll A., Rossen L. Births: provisional data for 2016. Vital Statistics Rapid Release No 2. Hyattsville (MD): National Center for Health Statistics; 2017.
Curtin S.C., Gregory K.D., Korst L.M., Uddin S.F. Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013. Natl Vital Stat Rep. 2015; 64(4):1–13, back cover.
Guise J.-M., Eden K., Emeis C., Denman M.A., Marshall N., Fu R.R., et al. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess (Full Rep). 2010; (191):1–397.
Dodd J.M., Crowther C.A., Huertas E., Guise J.-M., Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane database Syst Rev. 2013; (12):CD004224.
Little M.O., Lyerly A.D., Mitchell L.M., Armstrong E.M., Harris L.H., Kukla R., et al. Mode of delivery: toward responsible inclusion of patient preferences. Obstet Gynecol. 2008; 112(4):913–8.
Categorisation of urgency for caesarean section RANZCOG July 2018.
The Lancet. Stemming the global caesarean section epidemic. Lancet. 2018; 392(10155):1279.
Zeitlin J., Durox M., Macfarlane A., Alexander S., Heller G., Loghi M., et al. Using Robson’s Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study. BJOG An Int J Obstet Gynaecol. 2021; 128(9):1444–53.
Savelieva NA. Secondary infertility associated with a uterine scar niche after Cesarean section: abstract of Cand. Sci. (Med.) dissertation: 3.1.4. 2022. 25 p.
Shmakov RG, Baev OR, Pekarev OG, Pyregov AV, Karapetyan AO, Prikhodko AM, et al. Surgical techniques of Cesarean section. Textbook. /– M: Publishing House "Binom". 2019. 82 p.
American College of Obstetricians and Gynecologists. Vaginal birth after cesarean delivery. ACOG Practice Bulletin No. 205. Obstet Gynecol 2019; 133:e110–27.
Macones G.A., Peipert J., Nelson D.B., Odibo A., Stevens E.J., Stamilio D.M., et al. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol. 2005; 193(5):1656–62.
Costantine M.M., Fox K.A., Pacheco L.D., Mateus J., Hankins G.D. V, Grobman W.A., et al. Does information available at delivery improve the accuracy of predicting vaginal birth after cesarean? Validation of the published models in an independent patient cohort. Am J Perinatol. 2011; 28(4):293–8.
Chauhan S.P., Martin J.N., Henrichs C.E., Morrison J.C., Magann E.F. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature. Am J Obstet Gynecol. 2003; 189(2):408–17.
Silver R.M., Landon M.B., Rouse D.J., Leveno K.J., Spong C.Y., Thom E.A., et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107(6):1226–32.
Grantz K.L., Gonzalez-Quintero V., Troendle J., Reddy U.M., Hinkle S.N., Kominiarek M.A., et al. Labor patterns in women attempting vaginal birth after cesarean with normal neonatal outcomes. Am J Obstet Gynecol. 2015; 213(2):226.e1-6.
Kan NE, Shmakov RG, Kesova MI, Tyutyunnik VL, Baev OR, Pekarev OG, et al. Spontaneous delivery in patients with a uterine scar after Cesarean section. Clinical protocol. Obstetrics and Gynecology. 2016; (12):12–9.
Chaillet N., Bujold E., Dubé E., Grobman W.A. Validation of a prediction model for vaginal birth after caesarean. J Obstet Gynaecol Can. 2013; 35(2):119–24.
Yokoi A., Ishikawa K., Miyazaki K., Yoshida K., Furuhashi M., Tamakoshi K. Validation of the prediction model for success of vaginal birth after cesarean delivery in Japanese women. Int J Med Sci. 2012; 9(6):488–91.
Gambacorti-Passerini Z., Gimovsky A.C., Locatelli A., Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand. 2016; 95(7):724–34.
Li H., Sheng W., Cai M., Chen Q., Lin B., Zhang W., et al. A predictive nomogram for a failed trial of labor after cesarean: A retrospective cohort study. J Obstet Gynaecol Res. 2022; 48(11):2798–806.
Mekonnen B.D., Asfaw A.A. Predictors of successful vaginal birth after a cesarean section in Ethiopia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023; 23(1):65.
Atia O., Rotem R., Reichman O., Jaffe A., Grisaru-Granovsky S., Sela H.Y., et al. Number of prior vaginal deliveries and trial of labor after cesarean success. Eur J Obstet Gynecol Reprod Biol. 2021; 256:189–93.
Lazarou A., Oestergaard M., Netzl J., Siedentopf J.-P., Henrich W. Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors. J Perinat Med. 2021; 49(7):773–82.
Pekarev OG, Mayborodin IV, Pekareva EO, Pozdnyakov IM. Spontaneous delivery in patients with a uterine scar after Cesarean section. Realities and prospects. Women's Health and Reproduction. 2018; 9(28).
Mone F., Harrity C., Mackie A., Segurado R., Toner B., McCormick T.R., et al. Vaginal birth after caesarean section prediction models: a UK comparative observational study. Eur J Obstet Gynecol Reprod Biol. 2015; 193:136–9.
Palatnik A., Grobman W.A. Induction of labor versus expectant management for women with a prior cesarean delivery. Am J Obstet Gynecol. 2015; 212(3):358.e1-6.
Peaceman A.M., Gersnoviez R., Landon M.B., Spong C.Y., Leveno K.J., Varner M.W., et al. The MFMU Cesarean Registry: impact of fetal size on trial of labor success for patients with previous cesarean for dystocia. Am J Obstet Gynecol. 2006; 195(4):1127–31.
Committee on Practice Bulletins—Obstetrics. Practice Bulletin No 178: Shoulder Dystocia. Obstet Gynecol. 2017; 129(5):e123–33.
Coassolo K.M., Stamilio D.M., Paré E., Peipert J.F., Stevens E., Nelson D.B., et al. Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. Obstet Gynecol. 2005; 106(4):700–6.
Kiran T.S.U., Chui Y.K., Bethel J., Bhal P.S. Is gestational age an independent variable affecting uterine scar rupture rates? Eur J Obstet Gynecol Reprod Biol. 2006; 126(1):68–71.
Obstetric Care Consensus No. 2. Obstet Gynecol. 2015; 125(2):502–15.
Grobman W.A., Gilbert S., Landon M.B., Spong C.Y., Leveno K.J., Rouse D.J., et al. Outcomes of induction of labor after one prior cesarean. Obstet Gynecol. 2007; 109(2 Pt 1):262–9.
Hibbard J.U., Gilbert S., Landon M.B., Hauth J.C., Leveno K.J., Spong C.Y., et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol. 2006; 108(1):125–33.
Goodall P.T., Ahn J.T., Chapa J.B., Hibbard J.U. Obesity as a risk factor for failed trial of labor in patients with previous cesarean delivery. Am J Obstet Gynecol. 2005; 192(5):1423–6.
Bujold E., Hammoud A., Schild C., Krapp M., Baumann P. The role of maternal body mass index in outcomes of vaginal births after cesarean. Am J Obstet Gynecol. 2005; 193(4):1517–21.
Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018; 131(2):e49–64.
Levin G., Tsur A., Tenenbaum L., Mor N., Zamir M., Meyer R. Prediction of successful vaginal birth after cesarean in women with diabetic disorders and no prior vaginal delivery. Int J Gynaecol Obstet. 2022; 157(1):165–72.
Lappen J.R., Hackney D.N., Bailit J.L. Outcomes of Term Induction in Trial of Labor After Cesarean Delivery: Analysis of a Modern Obstetric Cohort. Obstet Gynecol. 2015; 126(1):115–23.
Stock S.J., Ferguson E., Duffy A., Ford I., Chalmers J., Norman J.E. Outcomes of induction of labour in women with previous caesarean delivery: a retrospective cohort study using a population database. PLoS One. 2013; 8(4):e60404.
Levin G., Tsur A., Tenenbaum L., Mor N., Zamir M., Meyer R. Prediction of successful trial of labor after cesarean among grand-multiparous women. Arch Gynecol Obstet. 2022; 306(2):373–8.
Goetzinger K.R., Macones G.A. Operative vaginal delivery: current trends in obstetrics. Womens Health (Lond Engl). 2008; 4(3):281–90.
ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019; 133(1):e1–25.
Zelop C.M., Shipp T.D., Repke J.T., Cohen A., Lieberman E. Outcomes of trial of labor following previous cesarean delivery among women with fetuses weighing >4000 g. Am J Obstet Gynecol. 2001; 185(4):903–5.
American College of Obstetricians and Gynecologists’ Committee on Ethics. Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy. Obstet Gynecol. 2016; 127(6):e175-82.
Obeidat N., Meri Z.B., Obeidat M., Khader Y., Al-Khateeb M., Zayed F., et al. Vaginal birth after caesarean section (VBAC) in women with spontaneous labour: predictors of success. J Obstet Gynaecol. 2013; 33(5):474–8.
Cahill A.G., Waterman B.M., Stamilio D.M., Odibo A.O., Allsworth J.E., Evanoff B., et al. Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2008; 199(1):32.e1-5.
Horenstein J.M., Phelan J.P. Previous cesarean section: the risks and benefits of oxytocin usage in a trial of labor. Am J Obstet Gynecol. 1985; 151(5):564–9.
Flamm B.L., Goings J.R., Fuelberth N.J., Fischermann E., Jones C., Hersh E. Oxytocin during labor after previous cesarean section: results of a multicenter study. Obstet Gynecol. 1987; 70(5):709–12.
Bujold E., Blackwell S.C., Gauthier R.J. Cervical ripening with transcervical foley catheter and the risk of uterine rupture. Obstet Gynecol. 2004; 103(1):18–23.
He X., Dai Q., Wu X., Zhou J., Li J. Outcomes and risk factors for failed trial of labor after cesarean delivery (TOLAC) in women with one previous cesarean section: a Chinese population-based study. BMC Pregnancy Childbirth. 2022; 22(1):676.
Flamm B.L., Goings J.R. Vaginal birth after cesarean section: is suspected fetal macrosomia a contraindication? Obstet Gynecol. 1989; 74(5):694–7.
Elkousy M.A., Sammel M., Stevens E., Peipert J.F., Macones G. The effect of birth weight on vaginal birth after cesarean delivery success rates. Am J Obstet Gynecol. 2003; 188(3):824–30.
Kok N., Wiersma I.C., Opmeer B.C., de Graaf I.M., Mol B.W., Pajkrt E. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis. Ultrasound Obstet Gynecol. 2013; 42(2):132–9.
Joura E.A., Nather A., Hohlagschwandtner M., Husslein P. The impact of a single- or double-layer closure on uterine rupture. Am J Obstet Gynecol. 2003; 189(3):895.
West H.M., Jozwiak M., Dodd J.M. Methods of term labour induction for women with a previous caesarean section. Cochrane database Syst Rev. 2017; 6:CD009792.
ACOG Practice Bulletin No. 205. Obstet Gynecol. 2019; 133(2):e110–27.
Savelieva NA. Secondary infertility associated with a uterine scar niche after Cesarean section: Cand. Sci. (Med.) dissertation: 3.1.4. 2022. 152 p.
Maymon R., Shulman A., Pomeranz M., Holtzinger M., Haimovich L., Bahary C. Uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor. Am J Obstet Gynecol. 1991; 165(2):368–70.
Raskin K.S., Dachauer J.D., Doeden A.L., Rayburn W.F. Uterine rupture after use of a prostaglandin E2 vaginal insert during vaginal birth after cesarean. A report of two cases. J Reprod Med. 1999; 44(6):571–4.
Zelop C.M., Shipp T.D., Repke J.T., Cohen A., Caughey A.B., Lieberman E. Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery. Am J Obstet Gynecol. 1999; 181(4):882–6.
Cogan A., Barlow P., Benali N., Murillo D., Manigart Y., Belhomme J., et al. An audit about labour induction, using prostaglandin, in women with a scarred uterus. Arch Gynecol Obstet. 2012; 286(6):1399–406.
Vause S., Macintosh M. Evidence based case report: use of prostaglandins to induce labour in women with a caesarean section scar. BMJ. 1999; 318(7190):1056–8.
Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol. 2009; 113(5):1117–23.
Berghella V., Airoldi J., O’Neill A.M., Einhorn K., Hoffman M. Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review. BJOG. 2009; 116(9):1151–7.
Hoffman M.K., Sciscione A., Srinivasana M., Shackelford D.P., Ekbladh L. Uterine rupture in patients with a prior cesarean delivery: the impact of cervical ripening. Am J Perinatol. 2004; 21(4):217–22.
Zhang H., Liu H., Luo S., Gu W. Oxytocin use in trial of labor after cesarean and its relationship with risk of uterine rupture in women with one previous cesarean section: a meta-analysis of observational studies. BMC Pregnancy Childbirth. 2021; 21(1):11.
Obstetrics: National Guidelines / ed. by G. M. Savelieva, G. T. Sukhikh, V. N. Serov, V. E. Radzinsky. - 2nd ed., rev. and suppl. M.: GEOTAR-Media. – 2018. – 1088 p.;
Eshkoli T., Weintraub A.Y., Baron J., Sheiner E. The significance of a uterine rupture in subsequent births. Arch Gynecol Obstet. 2015; 292(4):799–803.
Boyle A., Preslar J.P., Hogue C.J.R., Silver R.M., Reddy U.M., Goldenberg R.L., et al. Route of Delivery in Women With Stillbirth: Results From the Stillbirth Collaborative Research Network. Obstet Gynecol. 2017; 129(4):693–8.
Krasnopolsky VI, Logutova LS, Buyanova SN. Deficient uterine scar after Cesarean section: causes of formation and management tactics. Obstetrics and Gynecology. 2013; (12):28–33.
Hofmeyr G.J., Hannah M., Lawrie T.A. Planned caesarean section for term breech delivery. Cochrane database Syst Rev. 2015; (7):CD000166.
Ananth C. V, Smulian J.C., Vintzileos A.M. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol. 1997; 177(5):1071–8.
Obstetrics: National Guidelines / ed. by G. M. Savelieva, G. T. Sukhikh, V. N. Serov, V. E. Radzinsky. - 2nd ed., rev. and suppl. M.: GEOTAR-Media; 2018. 1088 p.
Farmakides G., Duvivier R., Schulman H., Schneider E., Biordi J. Vaginal birth after two or more previous cesarean sections. Am J Obstet Gynecol. 1987; 156(3):565–6.
ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2019; 133(2):e110–27.
Modzelewski J., Jakubiak-Proc M., Materny A., Sotniczuk M., Kajdy A., Rabijewski M. Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study. Ginekol Pol. 2019; 90(8):444–51.
Bretelle F., Cravello L., Shojai R., Roger V., D’ercole C., Blanc B. Vaginal birth following two previous cesarean sections. Eur J Obstet Gynecol Reprod Biol. 2001; 94(1):23–6.
Hansell R.S., McMurray K.B., Huey G.R. Vaginal birth after two or more cesarean sections: a five-year experience. Birth. 1990; 17(3):146–50; discussion 150-1.
Prikhodko AM, Baev OR, Lunkov SS, Eremina OV, Gus AI. Capabilities of methods for assessing the state of the uterine wall after Cesarean section. Obstetrics and Gynecology. 2013; (10):12–6.
Grobman W.A., Lai Y., Landon M.B., Spong C.Y., Leveno K.J., Rouse D.J., et al. Prediction of uterine rupture associated with attempted vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2008; 199(1):30.e1-5.
Schoorel E.N.C., Melman S., van Kuijk S.M.J., Grobman W.A., Kwee A., Mol B.W.J., et al. Predicting successful intended vaginal delivery after previous caesarean section: external validation of two predictive models in a Dutch nationwide registration-based cohort with a high intended vaginal delivery rate. BJOG. 2014; 121(7):840–7; discussion 847.
Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016; 124(2):270–300.
Familiari A., Neri C., Caruso A., Airoldi C., Barone-Adesi F., Zanconato G., et al. Vaginal birth after caesarean section: a multicentre study on prognostic factors and feasibility. Arch Gynecol Obstet. 2020; 301(2):509–15.
Jo Y.S., Lee G.S.R., Kim N., Jang D.G., Kim S.J., Lee Y. Clinical efficacy of cervical length and volume for prediction of labor onset in VBAC candidates. Int J Med Sci. 2012; 9(9):738–42.
Shipp T.D., Zelop C.M., Repke J.T., Cohen A., Caughey A.B., Lieberman E. Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions. Obstet Gynecol. 1999; 94(5 Pt 1):735–40.
Leung A.S., Farmer R.M., Leung E.K., Medearis A.L., Paul R.H. Risk factors associated with uterine rupture during trial of labor after cesarean delivery: a case-control study. Am J Obstet Gynecol. 1993; 168(5):1358–63.
MacKenzie I.Z., Cooke I. Prospective 12 month study of 30 minute decision to delivery intervals for “emergency” caesarean section. BMJ. 2001; 322(7298):1334–5.
Yildirim G., Beji N.K. Effects of pushing techniques in birth on mother and fetus: a randomized study. Birth. 2008; 35(1):25–30.
Senécal J., Xiong X., Fraser W.D., Pushing Early Or Pushing Late with Epidural study group. Effect of fetal position on second-stage duration and labor outcome. Obstet Gynecol. 2005; 105(4):763–72.
Thomson A.M. Pushing techniques in the second stage of labour. J Adv Nurs. 1993; 18(2):171–7.
Pervin J., Aktar S., Nu U.T., Rahman M., Rahman A. Associations between improved care during the second stage of labour and maternal and neonatal health outcomes in a rural hospital in Bangladesh. Midwifery. 2018; 66:30–5.
Hehir M.P., Rouse D.J., Miller R.S., Ananth C. V, Wright J.D., Siddiq Z., et al. Second-Stage Duration and Outcomes Among Women Who Labored After a Prior Cesarean Delivery. Obstet Gynecol. 2018; 131(3):514–22.
Broberg J.C., Caughey A.B. A randomized controlled trial of prophylactic early manual rotation of the occiput posterior fetus at the beginning of the second stage vs expectant management. Am J Obstet Gynecol MFM. 2021; 3(2):100327.
Thapa M., Saha R., Pradhan S., Thakur S., Rana A.S. Active management of third stage of labor. Nepal J Obstet Gynaecol. 1970; 1(2):25–7.
Jangsten E., Mattsson L.-Å., Lyckestam I., Hellström A.-L., Berg M. A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial. BJOG. 2011; 118(3):362–9.
Begley C.M. A comparison of “active” and “physiological” management of the third stage of labour. Midwifery. 1990; 6(1):3–17.
Lan Y., Pan S., Chen B., Peng L., Chen R., Hua Y., et al. Labor characteristics and intrapartum interventions in women with vaginal birth after cesarean section. BMC Pregnancy Childbirth. 2022; 22(1):589.
Tahseen S., Griffiths M. Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG. 2010; 117(1):5–19.
Phelan J.P., Korst L.M., Settles D.K. Uterine activity patterns in uterine rupture: a case-control study. Obstet Gynecol. 1998; 92(3):394–7.
Cai Y.-Q., Liu W., Zhang H., He X.-Q., Zhang J. Laparoscopic repair of uterine rupture following successful second vaginal birth after caesarean delivery: A case report. World J Clin cases. 2020; 8(13):2855–61.
Wang P.H., Yuan C.C., Chao H.T., Yang M.J., Ng H.T. Posterior uterine wall rupture during labour. Hum Reprod. 2000; 15(5):1198–9.
Majumdar S., Warren R., Ifaturoti O. Fetal survival following posterior uterine wall rupture during labour with intact previous caesarean section scar. Arch Gynecol Obstet. 2007; 276(5):537–40.
Gato M., Castro C., Pinto L. Antepartum Rupture of the Posterior Uterine Wall in a Woman With Two Previous Cesarean Deliveries. Cureus. 2024; 16(1):e52517.
Aigybayeva AN. Relevance of adhering to the intergenetic interval and the principles of preconception care for women at the primary care level of obstetric and gynecological services. Bulletin of the Kazakh National Medical University. 2018; (3):9–11.
Rao J., Fan D., Ma H., Lin D., Zhang H., Zhou Z., et al. Is there an optimal inter-delivery interval in women who underwent trial of labor after cesarean delivery (TOLAC)? Reprod Health. 2022; 19(1):14.
Appendix A1. Working Group Composition
Pekarev Oleg Grigorievich – MD, Professor, Deputy Director of the Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Baranov Igor Ivanovich – MD, Professor, Head of the Department of Scientific and Educational Programs, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Dolgushina Natalia Vitalievna – MD, Professor, Deputy Director for Research, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, Chief Freelance Specialist in Women's Reproductive Health of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Kan Natalia Enkynovna – Professor, MD; Deputy Director for Research, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Klimov Vladimir Anatolyevich – PhD, Head of the Medical Care Organization and Information Service, Head of the Department of Medical Care Organization, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Nikolaeva Anastasia Vladimirovna – PhD, Chief Physician, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Prikhodko Andrey Mikhailovich – Associate Professor, MD; Deputy Director for Research of the Institute of Obstetrics, Head of the Department of Innovative Development of the Institute of Obstetrics, Obstetrician-Gynecologist of the 1st Maternity Ward, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Romanov Andrey Yuryevich – PhD, Head of the Department of Planning and Support of Scientific Projects, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Serov Vladimir Nikolaevich – Academician of the RAS, MD, Professor, Chief Researcher, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, President of the Russian Association of Obstetricians and Gynecologists (ROAG) (Moscow). There is no conflict of interest.
Shmakov Roman Georgievich – MD, Professor, Professor of the RAS, Director of the Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky, Chief Freelance Specialist in Obstetrics of the Russian Ministry of Health (Moscow). There is no conflict of interest.
Natalia V. Artymuk – MD, PhD, Professor, Head of the Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University of the Russian Ministry of Health, Chief Freelance Specialist in Obstetrics, Gynecology, and Women's Reproductive Health of the Russian Ministry of Health in the Siberian Federal District (Kemerovo). No conflict of interest.
Nadezhda V. Bashmakova – MD, PhD, Professor, Chief Researcher, Ural Research Institute for Maternal and Infant Care of the Russian Ministry of Health, Chief freelance specialist in obstetrics, gynecology, and women's reproductive health of the Russian Ministry of Health in the Ural Federal District. No conflict of interest.
Bezhenar Vitaly Fedorovich – Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics, Gynecology and Reproductology at the Academician I.P. Pavlov First Saint Petersburg State Medical University of the Russian Ministry of Health, Chief Freelance Obstetrician-Gynecologist of the Healthcare Committee of the Government of Saint Petersburg (Saint Petersburg). No conflict of interest.
Belokrinitskaya Tatiana Evgenievna – D.Sc. in Medicine, Professor, Head of the Department of Obstetrics and Gynecology, Faculty of Additional Professional Education, Chita State Medical Academy of the Russian Ministry of Health, Honored Doctor of the Russian Federation, Chief freelance specialist in obstetrics of目 the Russian Ministry of Health, Chief freelance specialist in gynecology of the Russian Ministry of Health, Chief freelance specialist in women's reproductive health in the Far Eastern Federal District (Chita). No conflict of interest.
Lydia S. Logutova – Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Leading Researcher, Moscow Region Research Institute of Obstetrics and Gynecology (MONIIAG); Professor of the Department of Obstetrics and Gynecology, Faculty of Advanced Medical Training, Moscow Regional Research Clinical Institute (MONIKI) (Moscow). No conflict of interest.
Anna I. Malyshkina – Doctor of Medical Sciences, Professor, Director, V.N. Gorodkov Ivanovo Research Institute of Motherhood and Childhood; Head of the Department of Obstetrics and Gynecology, Medical Genetics, Faculty of General Medicine, Ivanovo State Medical Academy of the Russian Ministry of Health; Chief freelance specialist in obstetrics and chief freelance specialist in gynecology of the Russian Ministry of Health, Chief freelance specialist in women's reproductive health in the Central Federal District (Ivanovo). No conflict of interest.
Viktor E. Radzinsky – Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Obstetrics and Gynecology with a Course in Perinatology, Peoples' Friendship University of Russia under the Ministry of Education of Russia. No conflict of interest
Ildar F. Fatkullin – Doctor of Medical Sciences, Professor, Head of the Prof. V.S. Gruzdev Department of Obstetrics and Gynecology, Kazan State Medical University of the Russian Ministry of Health, Chief freelance specialist of the Russian Ministry of Health in obstetrics and gynecology in the Privolzhsky Federal District (Kazan). No conflict of interest.
Oleg S. Filippov – Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation, Chief Freelance Obstetrician-Gynecologist of the FMBA of Russia, Deputy Director of the Federal Research and Clinical Center of Children and Adolescents of the FMBA of Russia, Professor of the Department of Obstetrics, Gynecology and Reproductive Medicine, Russian University of Medicine (Moscow). No conflict of interest
Appendix A2. Methodology for Developing Clinical Guidelines
Target audience for these clinical guidelines:
Obstetricians-gynecologists.
Obstetrician-gynecologist residents.
Table 1. Level of Evidence (LoE) grading scale for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies with reference standard control or systematic reviews of randomized controlled trials with meta-analysis |
2 | Individual studies with reference standard control or individual randomized controlled trials and systematic reviews of studies of any design, except randomized controlled trials, with meta-analysis |
3 | Studies without consecutive reference standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | Only justification of mechanism of action or expert opinion is available |
Table 2. Scale for assessing levels of reliable evidence (LRE) for prevention, treatment, and rehabilitation methods (preventive, therapeutic, rehabilitation interventions)
LoE | Definitions |
|---|---|
1 | Systematic review of RCTs with meta-analysis |
2 | Individual RCTs and systematic reviews of studies of any design except RCTs, with meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table 3. Grade of Recommendation (GoR) scale for prevention, diagnostic, treatment, and rehabilitation methods (preventive, diagnostic, therapeutic, and rehabilitative interventions)
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or acceptable methodological quality, and their conclusions on the outcomes of interest are consistent) |
B | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Appendix A3. Reference Materials
Not applicable.
Appendix B. Physician Action Algorithms
Appendix C. Patient Information
CAN A WOMAN HAVE A VAGINAL DELIVERY AFTER A PREVIOUS CESAREAN SECTION?
Quite a few women who have previously given birth by cesarean section can deliver vaginally without risk to their health. Trial of labor after cesarean section (TOLAC) has a high success rate for vaginal delivery and many advantages over planned repeat cesarean section.
In cases where the trial of labor fails, a repeat cesarean section is performed.
Unfortunately, certain health problems or specific features of the current pregnancy and upcoming labor make a trial of labor with a uterine scar too risky for some women — in such cases, the patient will be recommended to undergo a repeat cesarean section.
WHAT ARE THE ADVANTAGES AND RISKS OF VAGINAL DELIVERY AFTER A PREVIOUS CESAREAN SECTION?
There are several advantages of vaginal delivery with a uterine scar compared to repeat cesarean section: reduced blood loss; absence of a postoperative wound and lower risk of infection; absence of risks associated with surgery and anesthesia; shorter hospital stay; less pain; and a reduced risk of complications such as placenta previa and placenta accreta in subsequent pregnancies. Cesarean delivery is becoming increasingly frequent. A trial of labor with a uterine scar after a cesarean section is successful in 75% of cases. The reasons for choosing this method of childbirth vary. Sometimes, an obstetrician-gynecologist may recommend a repeat cesarean section to a pregnant woman instead of a trial of labor due to a uterine scar from previous surgery. A trial of labor with a uterine scar after a cesarean section may conclude with a repeat cesarean section if certain obstetric situations arise. Uterine rupture occurs in 0.2–0.7% of vaginal deliveries with a uterine scar after a cesarean section. However, vaginal delivery is a safe method of childbirth for patients with a history of cesarean section.
WHAT DOES A PREGNANT WOMAN NEED TO KNOW?
The feasibility of a trial of labor with a uterine scar after a cesarean section is determined by a physician on a case-by-case basis. Medical documentation (discharge summary) received by the patient after the previous cesarean section can help the physician determine whether a trial of labor with a uterine scar after a previous cesarean section is appropriate in this specific case. Spontaneous onset of labor increases the chance of a successful trial of labor with a uterine scar after a cesarean section. The use of oxytocin** for labor induction and augmentation is not contraindicated, but is associated with an increased risk of TOLAC failure and uterine rupture.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
Appendix G1. Bishop score
Type: rating scale
Source: Teixeira C. et al. The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis //Archives of gynecology and obstetrics. – 2012. – Vol. 286. – P. 739-753.
Purpose: assessment of the cervical ripening score
Content:
Cervical status | Score | Score | |||
|---|---|---|---|---|---|
0 | 1 | 2 | 3 | ||
Cervical position | posterior | central/ anterior | - | - | |
Cervical consistency | firm | moderately soft | soft | - | |
Cervical length, cm | >4 | 2-4 | 1-2 | <1 | |
Dilatation, cm | <1 | 1-2 | 2-4 | >4 | |
Station of the presenting part | -3 above the pelvic inlet | -2 engaged | -1/0 low/deep in the pelvic cavity | +1/+2 in the cavity | |
Total Bishop score | |||||
Interpretation:
Cervical ripeness degree | Unripe | Insufficiently ripe | Ripe |
|---|---|---|---|
Bishop scores | 0-5 | 6-7 | 8-9 or more |
Notes:
Fill out before each stage of cervical pre-induction/induction of labor.
The Bishop score is the best available tool for assessing cervical ripening.
Ripe cervix – clinical signs of cervical readiness for labor (8 or more points).
Insufficiently ripe cervix – clinical signs of insufficient cervical readiness for labor (6–7 points).
Unripe cervix – absence of clinical signs of cervical readiness for labor (5 points or less)
Appendix G2. Scale for assessing the severity of the uterine niche
Clinical and instrumental data | Score | ||
|---|---|---|---|
0 | 1 | 2 | |
Clinical complaints (Secondary infertility, AUB) | - | - | + |
Residual myometrium thickness in the niche projection (according to SIS / MRI) | mm > 3 | 2 - 3 | < 2 |
Niche volume, cm3 | < 0,1 | 0,1 – 1,0 | > 1,0 |
Interpretation of results:
0–2 points – clinically insignificant niche
3–4 points – moderately pronounced niche
5–6 points – critical niche