Conducting Labor in Women with Previous Caesarean Section in a Low Gestational Week

Abstract

Aims: To assess whether vaginal labor after a previous caesarean section in a low gestational week performed by means of a high placed U-section technique could be recommended by obstetricians as a sufficiently safe method of choice for pregnant women. Methods: Of 309 pregnant women with a history of a high placed U-section, 166 (53.7%) met the criteria for the subsequent vaginal delivery and agreed with it. In 78%, vaginal labor started spontaneously and in 22% it was induced due to postterm pregnancy or preterm rupture of membranes. Results: Vaginallabor was successful in 72.3% of women. Deliveries after spontaneous onset of uterine contractions (80%) were considerably more successful. In the group of women with induced labor, the success rate was below 50%. Uterine rupture was not encountered in the study group. Conclusions: Vaginal labor after a previous high placed U-section is a sufficiently safe method of choice for selected groups of pregnant women, but it has to be mentioned that selecting criteria can only minimize and not entirely exclude the risk of uterine rupture.

ORIGINAL ARTICLE: Changes in the Subpopulation of CD25+ CD4+ and FOXP3+ Regulatory T Cells in Decidua with Respect to the Progression of Labor at Term and the Lack of Analogical Changes in the Subpopulation of Suppressive B7‐H4+ Macrophages – A Preliminary Report

“…13 It has been observed that in mice estrogen (17-beta-estradiol-E2) enhances Foxp3 expression in CD25 + T cells both in vitro and in vivo. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] It is a complex molecular response leading to a brief activation of the maternal immune system with an accompanying capacity to restrict this same activation. The beginning of labor is determined not only by the molecular changes in maternal-fetal interface, but most likely also by the activity of the fetal adrenals and related cofactors.…”

“…Certainly, the initiation of labor is accompanied by alterations in the level of maternal immune tolerance toward fetal antigens. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] It is a complex molecular response leading to a brief activation of the maternal immune system with an accompanying capacity to restrict this same activation. 1,18,20,22 An increase in lymphocyte activity during labor has been observed 18 as well as an alteration in the distribution of natural killer (NK) cells (CD56 + CD16 + ) and CD3 positive lymphocytes in the decidua basalis derived from both spontaneous vaginal delivery and cesarean sections.…”

Women with a Preterm Cesarean Have High Rates of Successful Trial of Labor in a Subsequent Term Pregnancy

“…Binder et al found that in a group of 166 women with a previous high placed U-incision between weeks 25 and 29, 72 percent had a successful vaginal delivery after previous preterm cesarean. 9 Kwee et al found a success rate of 86 percent in a group of 93 women who attempted vaginal delivery after a cesarean between 26 and 34 weeks. 10 Harper et al compared success rates of 508 women who had a first cesarean before 34 weeks to 12 027 women with first cesareans after 34 weeks.…”

“…6 The role of a previous preterm cesarean has also been investigated as a possible influencer of trial of labor success. [9][10][11] Prematurity in a previous cesarean is presumed to negatively influence vaginal birth success chance. Theoretically, the damage that is done when an incision is made in a preterm, undeveloped lower uterine segment might be more extended in than in a term, fully developed lower uterine segment.…”