ISSN 0300-9092 (Print)
ISSN 2412-5679 (Online)

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

Mateykovich E.A., Karpova I.A., Shevlyukova T.P., Topchiu I.F., Bratova O.V., Marchenko R.N., Polyakova V.A.

1) Tyumen State Medical University of the Ministry of Health of the Russian Federation, Tyumen, Russia; 2) Maternity Hospital No. 3, Tyumen, Russia; 3) Perinatal Center, Tyumen, Russia

Objective: To study the criteria used to select pregnant women with a uterine scar following a cesarean section (CS) for vaginal birth (VB) in level 2 maternity hospitals and to evaluate the effectiveness of these criteria in relation to birth outcomes. 
Materials and methods: This study was conducted at Maternity Hospital No. 3, a level 2 maternity hospital in Tyumen, which provides specialized, round-the-clock medical care for pregnant women. The study included 182 pregnant women with uterine scars from one CS who were observed between 2021 and 2023. Depending on the birth outcomes, the patients were divided into three groups: Group 1 included 85 women with a uterine scar who gave birth vaginally; group 2 included 45 women with a uterine scar who were admitted for VB but ultimately gave birth via CS (unsuccessful VB); and group 3 included 52 women with a uterine scar who underwent CS immediately. Clinical and anamnestic data, as well as the course of pregnancy and childbirth, were compared between these groups.
Results: The primary reason for operative delivery among pregnant women with uterine scars was the refusal of VB by the patients (n=45, 86.0%). Reasons for refusal included concerns about the child’s health due to complications, such as fetal hypoxia (n=20, 44.4%), labor dystocia (n=19, 42.2%), clinically narrow pelvis (n=4, 8.9%), and premature rupture of membranes (n=2, 4.4%). A comparison of successful and unsuccessful VB attempts that ended in surgical delivery revealed no statistically significant differences between the two patient groups in terms of maternal age, body mass index, time since the last childbirth, or gestational age. However, the gestational age was significantly lower in cases of VB refusal than in those with successful VB. The parity at birth was statistically significant. Most patients in the successful VB group had two or more previous births, whereas more than two-thirds of the births in the unsuccessful VB group had only second births (p=0.04).
Conclusion: Reproductive experience suggests that vaginal delivery is the better option. Careful monitoring of these births aids in the development of effective criteria for successful VB in women with uterine scars, thereby increasing their chances of having multiple children and addressing urgent demographic policy issues.

Authors' contributions: Mateikovich E.A., Topchiu I.F., Bratova O.V., Polyakova V.A. – article concept; Mateikovich E.A. – literature review, drafting of the manuscript; Mateikovich E.A., Topchiu I.F., Bratova O.V. – collection of empirical material; Mateikovich E.A., Karpova I.A., Shevlyukova T.P., Marchenko R.N. – material analysis; Mateikovich E.A., Topchiu I.F. – statistical analysis.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Tyumen SMU, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Mateykovich E.A., Karpova I.A., Shevlyukova T.P., Topchiu I.F., Bratova O.V., Marchenko R.N., Polyakova V.A. Uterine scar: cesarean section or vaginal birth? Impact on reproductive outcomes.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (5): 78-85 (in Russian)
https://dx.doi.org/10.18565/aig.2025.13

Keywords

pregnancy
childbirth
cesarean section
uterine scar
vaginal childbirth
parity of births
obstetric hospital

References

  1. World Health Organization Human Reproduction Programme, 10 April 2015. WHO Statement on caesarean section rates. Reprod. Health Matters. 2015; 23(45): 149-50. https://dx.doi.org/10.1016/j.rhm.2015.07.007
  2. Xu X.J., Jia J.X., Sang Z.Q., Li L. Association of caesarean scar defect with risk of abnormal uterine bleeding: results from meta-analysis. BMC Womens Health. 2024; 24(1): 432. https://dx.doi.org/10.1186/s12905-024-03198-6
  3. Martin J.A., Hamilton B.E., Osterman M.J.K. Births in the United States, 2016. NCHS Data Brief. 2017; (287): 1-8.
  4. WHO recommendations on health promotion interventions for maternal and newborn health 2015. World Health Organization; 2015. 86 p. Available at: https://iris.who.int/bitstream/handle/10665/172427/9789241508742_re?sequence=1
  5. Chen Y.T., Hsieh Y.C., Shen H., Cheng C.H., Lee K.H., Torng P.L. Vaginal birth after cesarean section: Experience from a regional hospital. Taiwan J. Obstet. Gynecol. 2022; 61(3): 422-6. https://dx.doi.org/10.1016/j.tjog.2022.03.006
  6. Antoine C., Young B.K. Cesarean section one hundred years 1920-2020: the good, the bad and the ugly. J. Perinat. Med. 2020; 49(1): 5-16. https://dx.doi.org/10.1515/jpm-2020-0305
  7. Матейкович Е.А. Качество оказания акушерско-гинекологической помощи и защита интересов врача в судебном разбирательстве. Акушерство и гинекология. 2018; 6: 92-8. [Mateikovich E.A. The quality of obstetric and gynecologic care and the protection of a physician’s interests in judicial proceedings. Obstetrics and Gynecology. 2018; (6): 92-8. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.6.92-98
  8. Habak P.J., Kole M. Vaginal birth after cesarean delivery. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
  9. Grobman W.A., Sandoval G., Rice M.M., Bailit J.L., Chauhan S.P., Costantine M.M. at al. Prediction of vaginal birth after cesarean delivery in term gestations: a calculator without race and ethnicity. Am. J. Obstet. Gynecol. 2021; 225(6): 664.e1-664.e7. https://dx.doi.org/10.1016/j.ajog.2021.05.021
  10. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Роды одноплодные, родоразрешение путем кесарева сечения. 2024. [Ministry of Health of the Russian Federation. Clinical guidelines. Singleton births, delivery by cesarean section. 2024. (in Russian)].
  11. Mascarello K.C., Horta B.L., Silveira M.F. Maternal complications and cesarean section without indication: systematic review and meta-analysis. Rev. Saude Publica. 2017; 51: 105. https://dx.doi.org/10.11606/S1518-8787.2017051000389
  12. Кузнецова Н.Б., Ильясова Г.М., Буштырева И.О., Гимбут В.С., Павлова Н.Г. Факторы риска влагалищных родов после кесарева сечения. Акушерство и гинекология. 2023; 10: 78-85. [Kuznetsova N.B., Ilуasova G.M., Bushtyreva I.O., Gimbut V.S., Pavlova N.G. Risk factors for vaginal delivery after cesarean section. Obstetrics and Gynecology. 2023; (10): 78-85 (in Russian)]. https://dx.doi.org/10.18565/aig.2023.121
  13. Савельева Г.М., Курцер М.А., Бреслав И.Ю., Коноплянников А.Г., Латышкевич О.А. Разрывы матки в современном акушерстве. Акушерство и гинекология. 2020; 9: 48-55. [Savelyeva G.M., Kurtser M.A., Breslav I.Yu., Konoplyannikov A.G., Latyshkevich O.A. Uterine ruptures in modern obstetrics. Obstetrics and Gynecology. 2020; (9): 48-55 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.9.48-55
  14. Naz S., Bano I., Rashid S., Fatima Y., Humayun P., Muzaffar T. Frequency of vaginal birth after caesarean section and its fetomaternal outcome. J. Ayub. Med. Coll. Abbottabad. 2023; 35(4): 583-7. https://dx.doi.org/10.55519/JAMC-04-12015
  15. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet. Gynecol. 2019; 133(2): e110-e127. https://dx.doi.org/10.1097/AOG.0000000000003078
  16. Parveen S., Rengaraj S., Chaturvedula L. Factors associated with the outcome of TOLAC after one previous caesarean section: a retrospective cohort study. J. Obstet. Gynaecol. 2021; 42(3): 430-6. https://dx.doi.org/10.1080/01443615.2021.1916451
  17. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Послеоперационный рубец на матке, требующий предоставления медицинской помощи матери во время беременности, родов и в послеродовом периоде. 2024. [Ministry of Health of the Russian Federation. Clinical guidelines. Postoperative scar on the uterus requiring medical care for the mother during pregnancy, childbirth and in the postpartum period. 2024. (in Russian)].
  18. Кан Н.Е., Шмаков Р.Г., Кесова М.И., Тютюнник В.Л., Баев О.Р., Пекарев О.Г., Тетруашвили Н.К., Клименченко Н.И. Самопроизвольное родоразрешение пациенток с рубцом на матке после операции кесарева сечения. Клинический протокол. Акушерство и гинекология. 2016; 12(Приложение): 12-9. [Kan N.E., Shmakov R.G., Kesova M.I., Tyutyunnik V.L., Baev O.R., Pekarev O.G., Tetruashvili N.K., Klimenchenko N.I. Spontaneous delivery is women with a uterine scar after cesarean section. Clinical protocol. Obstetrics and Gynecology. 2016; 12(Suppl.): 12-9. (in Russian)].
  19. Федеральная служба государственной статистики (Росстат). Здравоохранение в России 2023. Статистический сборник. М.: Росстат; 2023. 179 с. [Federal State Statistics Service (Rosstat). Healthcare in Russia 2023. Statistical collection. Moscow: Rosstat; 2023. 179 p. (in Russian)].
  20. Рудзевич А.Ю., Кукарская И.И., Хасанова В.В. Анализ частоты кесарева сечения с использованием классификации Робсона в родильных домах Тюменской области и Перинатальном центре города Тюмени. Международный журнал прикладных и фундаментальных исследований. 2021; 11: 45-9. [Rudzevich A.Yu., Kukarskaya I.I., Khasanova V.V. Analysis of the frequency of cesarean section using the Robson classification in maternity hospitals in the Tyumen region and the perinatal center in Tyumen. International Journal of Applied and Fundamental Research. 2021; 11: 45-9 (in Russian)]. https://dx.doi.org/10.17513/mjpfi.13310
  21. Горев В.В., Михеева А.А. Маршрутизация беременных как один из путей снижения младенческой смертности. Здоровье мегаполиса. 2021; 2(3): 17-23. [Gorev V.V., Mikheeva A.A. Routing of pregnant women as one of the ways to reduce infant mortality. City Healthcare. 2021; 2(3): 17-23. (in Russian)]. https://dx.doi.org/10.47619/2713-2617.zm.2021.v2i3;17-23
  22. Рудзевич А.Ю., Тлашадзе Р.Р., Попкова Л.А. Анализ частоты кесарева сечения по методу Робсона в родильном доме 2-го уровня. Международный журнал прикладных и фундаментальных исследований. 2021; 8: 16-20. [Rudzevich A.Y., Tlashadze R.R., Popkova L.A. Analysis of the frequency of caesarean section according to the Robson method in the second-level hospital. International Journal of Applied and Fundamental Research. 2021; 8: 16-20. (in Russian)]. https://dx.doi.org/10.17513/mjpfi.13256
  23. Вученович Ю.Д., Новикова В.А., Радзинский В.Е., Васильченко М.И., Трыкина Н.В., Старцева Н.М., Яроцкая И.А. Гистологические детерминанты попытки вагинальных родов после кесарева сечения. Акушерство и гинекология. 2022; 5: 128-39. [Vuchenovich Yu.D., Novikova V.A., Radzinsky V.E., Vasilchenko M.I., Trykina N.V., Yarotskaya I.A. Histological determinants of trial of labor after cesarean delivery. Obstetrics and Gynecology. 2022; (5): 128-39 (in Russian)]. https://dx.doi.org/10.18565/aig.2022.5.128-139

Received 24.01.2025

Accepted 26.05.2025

About the Authors

Elena A. Mateykovich, PhD, Associate Professor, Director of the Institute of Maternity and Childhood, Tyumen State Medical University, Ministry of Health of the Russian Federation, 625023, Russia, Tyumen Oblast, Tyumen, Odesskaya str., 54, main building, office 310, +7(3452)69-07-58, mateykovichea@tyumsmu.ru,
https://orcid.org/0000-0002-2612-7339
Irina A. Karpova, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Head of the Center of the Scientific and Clinical Center of Geostasis and Genetics of the Multidisciplinary University Clinic, Tyumen State Medical University, Ministry of Health of the Russian Federation,
625023, Russia, Tyumen region, Tyumen, Odesskaya str., 54, main building, 6th floor, +7(3452)69-08-00, karpovai.73@mail.ru, https://orcid.org/0000-0001-8688-5695
Tatyana P. Shevlyukova, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology, Tyumen State Medical University, Ministry of Health of the Russian Federation, 625002, Russia, Tyumen region, Tyumen, Daudelnaya str., 1, build. 3, 1st floor, +7(3452)69-07-58, tata21.01@mail.ru, https://orcid.org/0000-0002-7019-6630
Inna F. Topchiu, PhD student at the Department of Obstetrics and Gynecology, Tyumen State Medical University, Ministry of Health of the Russian Federation;
obstetrician-gynecologist, Maternity Hospital No. 3 of Tyumen, 625032, Russia, Tyumen region, Tyumen, Bauman str., 31 build. 1, +7(3452)24-94-46,
zula08061998@yandex.ru, https://orcid.org/0000-0002-3149-8660
Olga V. Bratova, Chief Physician, Maternity Hospital No. 3 of Tyumen; Teaching Assistant at the Department of Obstetrics and Gynecology, Tyumen State Medical University, Ministry of Health of the Russian Federation, 625002, Russia, Tyumen Oblast, Tyumen, Daudelnaya str., 1, build. 3, 1st floor, +7(3452)24-94-46, rd3@med-to.ru
Roman N. Marchenko, Head of the Obstetrics Department, Perinatal Center (Tyumen); Teaching Assistant at the Department of Obstetrics and Gynecology, Tyumen State Medical University, Ministry of Health of the Russian Federation, 625002, Russia, Tyumen Oblast, Tyumen, Daudelnaya str., 1, build. 3, 1st floor, +7(3452)69-07-58, marchenkorn@med-to.ru, https://orcid.org/0000-0002-2073-8120
Valentina A. Polyakova, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Tyumen State Medical University, Ministry of Health of the Russian Federation, 625002, Russia, Tyumen Oblast, Tyumen, Daudelnaya str., 1, build. 3, 1st floor, +7(3452)69-07-58, polycova_gyn@mail.ru, https://orcid.org/0000-0001-7008-1107

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