What are the indications for vaginal delivery in patients with uterine scar?

For female friends, pregnancy is the happiest yet painful period in their lives. In the medical field, vaginal trial delivery is not recommended for women with a scarred uterus, narrow pelvis, insufficient amniotic fluid, fetal intrauterine hypoxia, multiple pregnancy, uterine incision infection, etc. Next, let us understand the indications for vaginal trial delivery in patients with uterine scar.

Indications for vaginal delivery in patients with uterine scarring are as follows:

1. The previous cesarean section was a transverse incision in the lower uterine segment. There was no incision tearing during the operation, and the incision healed well after the operation without infection.

2. The current pregnancy is 2 years or more from the previous cesarean section.

3. Ultrasound showed that the scar thickness of the anterior wall of the lower uterine segment was more than 2 to 4 mm, with no weak areas.

4. No history of uterine scar or uterine rupture due to myomectomy, hysteroscopic electrosurgical resection, etc.

5. Before vaginal trial delivery, color Doppler ultrasound examination is performed to assess the size of the fetus, and the fetal weight should be less than 4000 g.

6. The indication for the previous cesarean section no longer exists and no new indication for cesarean section has emerged.

7. No serious pregnancy complications and no other internal or external medical complications that make vaginal delivery unsuitable.

8. During the trial birth, the labor progressed smoothly; this pregnancy met the conditions for vaginal delivery, and there were no abnormalities in the three elements of delivery; the intrapelvic measurement examination was normal.

9. The fetus is stillborn or has severe deformity.

10. There are better medical monitoring equipment, doctors can be on site at any time to monitor delivery, anesthesia can be performed immediately, emergency cesarean section surgeons can be on site at any time, and the conditions for surgery, blood transfusion and rescue are in place at any time.

Uterine scars: vaginal delivery is not recommended

The first is that the pathological indications for the first cesarean section still exist, such as a narrow pelvis, pelvic disproportion, oligohydramnios, malposition of the fetus, soft intestinal malformation or stenosis, etc.

The second is that the pregnant mother has other serious complications, such as pregnancy complicated by heart disease, pancreatitis, appendicitis, etc.

The third is serious obstetric complications during the second pregnancy. These complications may or may not occur with the first pregnancy, such as severe placenta previa, placental abruption, etc.

The fourth is the problems that may exist with the second child, such as fetal intrauterine hypoxia, multiple pregnancy, intrauterine infection, and the fetus being too large.

The fifth is poor healing of the uterine incision from the first cesarean section, such as uterine incision infection, uneven thickness, too thin incision scar, a history of uterine incision rupture, or the first surgical incision was a heavy uterine incision, severe lacerations in the incision requiring repair surgery, etc.

Sixth, there is a lack of confidence in natural childbirth, and family members or pregnant women cannot accept the possibility of switching from natural childbirth to cesarean section.

Seventh, due to special obstetric conditions diagnosed by other doctors, vaginal trial delivery cannot be performed, because the risk of vaginal trial delivery is greater than that of a scarred uterus. Therefore, if you have the above conditions, the doctor will not recommend you to have a vaginal trial delivery.