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

DOI

https://dx.doi.org/10.18565/aig.2025.13

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

pregnancy

childbirth

cesarean section

uterine scar

vaginal childbirth

parity of births

obstetric hospital

Full text (in Russian)

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Received 24.01.2025

Accepted 26.05.2025

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

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.

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