Abstract
Background: Delivery planning for women with a previous caesarean delivery can begin with preconception counselling but should be addressed early in prenatal care.1,2 One of the most important and difficult challenges facing the field of obstetrics is VBAC34 It has been shown to reduce overall rates of CS and eliminate the need for major surgery.5
Aim of the study: This study aimed to establish the effect measurement of the scar parameters on the uterus after a previous caesarean delivery that was evaluated by 3D ultrasound on the mode of the subsequent delivery mode.
Patients and method: An observational, prospective study conducted on 140 women aged between (23 – 40) years who attended the obstetrics-gynaecology clinic in Bent Al-Huda Teaching Hospital during the period from March 2023 to March 2024 in Al Nasiriyah City, Thi-Qar Province, Iraq. All had a previous caesarean section (CS) before at least a year, and their gestation age ranged between (35-39) weeks. For all women who completed the study, ultrasonography (US) was done for them, followed up until delivery according to the practice guidelines.
Results: About (97.1%) of the women with vaginal birth had triangular scars. All the women with (>3.5mm) of scar thickness ended with VB. All the variables of scar are significantly associated with the outcome of labour. Most of the women in this study were pregnant at 37 weeks (26.43%), had thirty months (25.71%) as the interpregnancy interval prior to their current pregnancy while most of the women who had a caesarean section had a ballon scar (81.4%), less than 3.5 mm of scar thickness (95.7%), an outer scar border (95.7%), a homogenous structure of the LUS (64%), hypervascularization (64%), up to 10 mm of scar volume (100%), and discontinuity (87.1%).
Conclusion: Vaginal birth for women who have undergone a previous caesarean section may be safe under specific conditions, based on the results of the scar parameters, and the decision of the obstetrician-gynaecologist
Recommendations: There is an urgent need for more studies from various Iraqi governorates, with a larger sample size, to confirm the results of this study, and may reduce the number of women who undergo caesarean section.