Introduction. In developed countries the attempts of vaginal delivery after cesarian section are not an unjustified risk, but considered the most favorable outcome. In Russia, unfortunately, obstetricians do not risk offering a vaginal birth to pregnant women after cesarian section, and outpatient doctors often adjust the abdominal delivery from early stages of pregnancy. The aim of the study: to identify specifics of labor and outcome of delivery for vaginal birth after previous cesarean and determine possible ways to reduce the frequency of abdominal delivery in these patients. Materials and methods. We conducted a retrospective analysis of 337 histories of delivery of patients after previous cesarean in 2016 in “Maternity hospital No 13”. The main group consisted of 189 patients to whom vaginal birth was planned, of which 82 patients completed the birth in accordance with the previous plan (subgroup 1) and 107 women completed cesarean section (group 2). The control group consisted of 148 women who had cesarean delivery without trial vaginal delivery. Results. Among the indications for the first cesarean section in the subgroup 1 were: breech malpresentation – 19.7%, fetal hypoxia – 22.4% and abnormalities of the uterine contractile activity – 13.2%. The most common indications for a second operation in the 2nd subgroup were: premature rupture of amniotic fluid and absence of spontaneous labor (28%), lack of cervical muturity (21.5%), abnormalities of the uterine contractile activity (18.7%), fetal hypoxia (14%), abnormal preliminary period (13.1%), placental abruption (1.9%), absence of the effect of induction (amniotomy) (1.9%), cepalopelvic disproportion (0.9%). Thus, the percentage of success of vaginal delivery was 43.3%. At the same time, the fact of the presence of uterine contractions during the previous delivery did not affect the mode of delivery in this pregnancy. The volume of blood loss in cases of vaginal delivery was significantly less than in the subgroups of patients delivered by cesarean section. Conclusions. The analysis may lead to reviewing indications and terma for the birth after cesarean. Reserve groups have been defined for high chances of vaginal delivery: prolongation of pregnancy up to 41 weeks, induction and augmentation of labor, conservative management of labor with presumed macrosomia, that may help reduce the frequency of repeated abdominal delivery, development of intra- and postoperative complications.

Hypothesis/aims of study. The frequency of surgical abdominal delivery in Russia, as in the world, continues to grow, reaching 29.3% in 2017. Operative vaginal delivery is an alternative to abdominal delivery in the second stage of labor. This study was aimed at analyzing the outcome of labor for mothers and newborns using different operative vaginal delivery methods. Study design, materials and methods. We studied 293 cases of childbirth in the period from 2015 to 2018. Three groups were distinguished: (I) the main group consisting of 172 women delivered by the operation of applying obstetric forceps (OF); (II) the comparison group including 85 patients delivered by the operation of vacuum extraction (VE) with the fetal head being near the pelvic floor; and (III) the control group comprising 34 cases of vaginal birth without use of instrumental delivery. In group I, 114 patients were delivered by the low forceps operation (subgroup IA), and 60 individuals by the mid forceps operation (subgroup IB). Results. Vaginal lacerations were found in 21.3% of cases in group I, less often less often in groups II (10.6%, p 0.05) and III (2.9%, p 0.05). Vaginal hematoma occurred in one patient of group III (2.9%) and three women of group I (1.7%, p 0.05). There were no cases of damage to the anal sphincter. The greatest blood loss was recorded in subgroup IB (554 44.9 ml), when compared to subgroup IA (473 20.7 ml; p 0.05), group II (418 24.9 ml; p 0.05), and group III (347 33.4 ml; p 0.05). There were no differences in blood loss between the outlet OF and VE groups (p 0.05). Most newborns were born in good condition (84.5%, 77.6%, and 88.2% of cases in groups I, II, and III, respectively). Cephalohematoma in newborns was more common after VE (32.9%) than after OF (9.2%, p 0.01) and in control (5.9%, p 0.01). No retinal hemorrhage was recorded in newborns. There were no significant differences in the frequency of children being transferred to the childrens hospital (7.5%, 9.4%, and 8.8% of cases in groups I, II, and III, respectively; p 0.05). Conclusion. The use of OF is an effective and safe method of vaginal operative delivery. It does not increase the fetal injury rate, the frequency of newborn cephalohematoma being 3.5 times less than with VE. Complications of OF and VE (except for a greater number of vaginal lacerations in cases of OF), blood loss, and the course and duration of the postpartum stay in the maternity ward are comparable.