Assessment of Vaginal Delivery after Caesarean Section

In the last two decades, the rate of attempted vaginal delivery after previous cesarean birth has decreased, but the success rate of these deliveries increased. The main complication remains the uterine rupture with potential devastating complications both for the mother and the fetus. However, numerous authors reported a global risk for complications that doesn't exceed 2% and no more than 1% for uterine rupture. Maternal mortality and morbidity are higher but not significantly higher. The global risk for perinatal death in the first group is also higher (1-2,9/1000 vs 0-1,8/1000). The evaluation of the uterine scar using ultrasound still holds numerous controversies and its utility in practice remains limited. One of the factors is related with the modifications of the scar throughout the pregnancy. We conducted a study in our service and we evaluated 63 patients with a history of cesarean delivery in the second and third trimester and we correlated our findings with measurements of the scar. There were no significant modifications, thus suggesting that ultrasound might be a reliable investigation tool in the latter part of the pregnancy. The clinical implications of these findings are still to be established as well as the importance of the evaluation in itself for selecting the right patients with a previous c section for a vaginal delivery.