ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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An Alternative to Repeat Cesarean Section

DOI:10.31550/1727-2378-2020-19-6-15-22
For citation: Vuchenovich Yu.D., Novikova V.A., Radzinsky V.E. An Alternative to Repeat Cesarean Section. Doctor.Ru. 2020; 19(6): 15–22. (in Russian) DOI: 10.31550/1727-2378-2020-19-6-15-22
23 July 14:29

Study Objective: To increase the effectiveness of conservative delivery in women with a history of cesarean section (CS).

Study Design: This was a prospective, multicenter, cohort study.

Materials and Methods: The study was conducted at Moscow maternity hospitals No. 68 and No. 29 between 2013 and 2019. The study population comprised 372 pregnant women with a history of CS who insisted on a vaginal delivery. Delivery method was chosen based on clinical protocols.

Binary logistic regression was used to forecast the binary outcome based on an independent predictor, and automated neural network regression was used to forecast numerical or categorical variables based on one or several numerical or categorical predictors.

Study Results: In 43.55% of the women vaginal delivery was not possible for obstetric/non-obstetric reasons, while for 56.45%, including those with a history of two CS, there was a chance of having a vaginal delivery. Spontaneous/induced labor was reported in 51.08% of the patients in this study cohort, 52.63% of whom proceeded to have a vaginal delivery. Intranatal problems that impeded an attempt at a vaginal delivery were failure of treatments for prolonged labor and the impossibility of ruling out a developing uterine rupture.

Conclusion: Women with a history of CS have the right to seek a vaginal delivery, but the approach to choosing a delivery method needs to be well-founded. In megalopolises it is possible to attempt a vaginal delivery in 56.45% of women with a history of one or two CS.

Contributions: Dr. Yu.D. Vuchenovich designed the study, outlined its goal and objectives, extracted data from source medical records, selected units of observation, analyzed results, did statistical analysis, selected sources of literature, and co-authored the paper. Dr. V.A. Novikova formulated the working hypothesis, analyzed and interpreted results, did statistical analysis, selected sources of literature, and co-authored the paper. Dr. V.E. Radzinsky designed the study, outlined its goal and objectives, formulated the working hypothesis, and approved the final version of the manuscript submitted for publication.

Conflict of interest: The authors declare that they do not have any conflict of interests.

Yu.D. Vuchenovich (Corresponding author) — N.E. Bauman City Clinical Hospital No. 29 (a Government-funded Healthcare Institution), Moscow City Department of Health; 2 Gospitalnaya Square, Moscow, Russian Federation 111020. Peoples’ Friendship University of Russia (a Federal Government Autonomous Educational Institution of Higher Education); 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. ORCID: http://orcid.org/0000-0002-7152-4560. E-mail: vuchrd15@mail.ru

V.A. Novikova — Peoples’ Friendship University of Russia (a Federal Government Autonomous Educational Institution of Higher Education); 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. ORCID: http://orcid.org/0000-0002-6109-7331. E-mail: vladislavan@mail.ru

V.E. Radzinsky — Peoples’ Friendship University of Russia (a Federal Government Autonomous Educational Institution of Higher Education); 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. eLIBRARY.RU SPIN: 4507-7510. ORCID: http://orcid.org/0000-0003-4956-0466. E-mail: radzinsky@mail.ru

Доктор.ру

Fig. 1. Linear relationship between the number of prior cesarean sections and the women’s age (А) and pregestational body mass index (BMI) (Б).
Note: In figures and tables: CS = cesarean section

r2_1.jpg 

Fig. 2. Methods of delivery in the study cohort (n = 372)

r2_2.jpg

Table 1
Pregestational and gestational clinical and medical-history characteristics of women in the study cohort (n = 372)

t2_1.jpg

Table 2
Mathematical models for forecasting the probability of an attempt at vaginal delivery and antenatal cesarean section, based on pregestational and gestational predictors

t2_2.jpg

Fig 3. Prediction of pregestational body mass index for various numbers of prior cesarean sections and the availability (yes/no) of an attempt at vaginal delivery. Neural network regression.
Note: MLP = multilayer perceptron, RBF = radial basis function

r2_3.jpg

Fig 4. Frequency of dysfunctional labor in patients with abdominal and vaginal delivery, %

r2_4.jpg

Fig 5. Methods of delivery in the study cohort (n = 372)

r2_5.jpg

Received: 30.03.2020
Accepted: 06.04.2020

23 July 14:29
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