Risk of uterine rupture during a trial of vaginal labor after cesarean

• Yulia D. Vuchenovich
• Vladislavа A. Novikovа
• Igor N. Kostin
• Victor E. Radzinsky

Abstract

The aim of this study - predicting uterine scar failure during trial of vaginal labor after cesarean (CS).

Material and methods. A prospective multicenter cohort study was carried out (2013-2019; Moscow). 372 patients with a history of CS were selected, 190 of whom were given an trial of vaginal labor, 182 were at antenatal period.

Results. At the age of 32.78±4.19 years, 38.17% of women had more than one history of CS. The interval between the previous CS and current pregnancy ranged from 1 to 19 years. The trial of vaginal labor was successful in 100 women. The ultrasound thickness of the scar in patients with antenatal, intrapartum CS and vaginal delivery was comparable (p>0.05). The ultrasound thickness of the uterine scar proved an uninformative independent predictor of the viability of the uterine scar when trial of vaginal labor after CS. A significant prediction model was determined by a combination of factors: age, BMI, history of CS, interval from previous CS, amniotic fluid index, minimum maximum scar thickness, resistance index of the right and left uterine arteries before delivery, gestational age at delivery, cervical maturity (the accuracy of prediction 91.94%).

Conclusion. An ultrasound assessment of the thickness of the myometrium in the uterine scar is not a guarantee of a successful trial of vaginal labor after CS, does not exclude the failure of the scar, uterine rupture. The outcome of a trial of vaginal labor after CS determines the combination of factors having pregestational, gestational and intranatal determinants. It is possible to predict the likelihood of scar thinning up to 1.0 mm with an accuracy of 100%.

Keywords:cesarean section, trial of vaginal labor after cesarean, uterine scar after cesarean section, uterine rupture

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