[Natural Childbirth after the Previous Caesarian Section is a Solved Problem].

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health

Background:

• Rising cesarean section (CS) rates, reaching up to 60% globally, negatively impact population reproductive potential.
• An operated uterus is a primary indication for repeat CS (up to 40%), highlighting a need for alternative delivery methods.
• Vaginal birth after cesarean (VBAC) is a key strategy to reduce overall CS frequency.

Purpose of the Study:

• To evaluate a novel two-stage delivery technology for patients with a uterine scar from a previous cesarean.
• To assess the safety and efficacy of programmed delivery methods in facilitating vaginal birth after cesarean (VBAC).

Main Methods:

• Comparative analysis of maternal and neonatal outcomes in patients with a history of cesarean.
• Development and implementation of a two-stage delivery protocol, incorporating programmed delivery techniques.

Main Results:

• The developed algorithm demonstrated the feasibility of vaginal birth in patients with a cesarean scar.
• This approach reduced complication rates by up to fourfold compared to previous methods.
• Neonatal morbidity rates for infants born vaginally after cesarean were comparable to those of physiological births.

Conclusions:

• The two-stage delivery technology, including programmed delivery, is a valid and effective method for reducing cesarean rates.
• This strategy improves maternal outcomes and maintains neonatal safety in women with a history of cesarean delivery.