Evaluation of the factors influencing labor outcomes in women with a history of abdominal delivery

Abstract

BACKGROUND: The rapid increase in the frequency of caesarean sections has led to the emergence of a special group of patients with a uterine scar who want to give birth through the natural birth canal. Repeated operative delivery is associated with high risks of both intraoperative and postoperative complications, therefore, every year the number of women with a uterine scar who prefer natural childbirth is growing.

AIM: The aim of this study was to create a model that allows, based on a comprehensive assessment of risk factors, for predicting the outcome of childbirth in women with a history of abdominal childbirth.

MATERIALS AND METHODS: We carried out a retrospective analysis of 173 birth histories of women with a uterine scar after a previous caesarean section, delivered in the Chita City Maternity Hospital in 2021–2022. Three groups of individuals were designed for the study: Group 1 included 110 women delivered by caesarean section in a planned manner; Group 2 comprised 20 women delivered by caesarean section during childbirth, while Group 3 consisted of 43 women who gave birth through the natural birth canal. The groups were comparable in terms of nationality, age, material and social conditions of the patients. On the eve of delivery, all patients underwent general clinical and obstetric ultrasound examination, with the anamnesis details clarified. The data obtained were processed statistically using the IBM SPSS Statistics version 25.0.

RESULTS: Using binary logistic regression, a model was developed to predict the outcome of childbirth through the natural birth canal in women with a uterine scar, which takes into account statistically significant indicators such as gestational age, estimated fetal weight, parity, and the presence of chronic endometritis and weakness of labor activity in history. The sensitivity of the developed prognostic model is 0.86, the specificity being 0.70. The area under the ROC curve is 0.87 (95% confidence interval 0.78–0.96; p < 0.001).

CONCLUSIONS: The comprehensive analysis of risk factors allows for predicting the outcome of natural childbirth in women with a uterine scar, which in the future will optimize the tactics of their delivery and prevent the development of complications in childbirth for the mother and fetus.

Keywords

uterine scar / labor with a uterine scar / cesarean section

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Mochalova M.N., Alekseyeva A.Y., Akhmetova E.S., Mudrov V.A.