External cephalic version (ECV) is a common procedure and has been shown to be safe and effective in turning a baby from a breech to cephalic presentation. However, whether ECV is safe and effective in women with a scarred uterus from a previous caesarean section remains contentious.
To evaluate the safety and efficacy of external cephalic version in women with a singleton breech pregnancy and at least one previous caesarean delivery.
Literature searches were conducted on MEDLINE, PUBMED, EMBASE, CINAHL and SCOPUS up to June 2020. The search strategy included the following keywords: (\'external cephalic version OR ECV\') AND (\'previous OR prior OR past\' AND \'caesarean OR caesarean OR uterine scar\'). Studies were included if they evaluated the efficacy and/or safety of external cephalic version in women after 36 weeks\' gestation with a singleton breech pregnancy and at least one previous caesarean delivery.
Nine studies were included in the review. ECV success rates and subsequent vaginal delivery rates ranged from 50 to 100% and from 50 to 74.9%, respectively. ECV complications reported included abnormal fetal heart rate, abnormal cardiotocography and transient vaginal bleeding. No studies reported cases of uterine rupture.
ECV in women with a previous caesarean delivery is a relatively successful and low-risk procedure compared to women without a previous caesarean delivery. The results from this systematic review provide useful information for professional bodies in updating clinical guidelines such that ECV may be offered to women with one previous caesarean delivery.

UNASSIGNED: Invasive placenta is a rare obstetrical pathology that is life-threatening to mother and child. It is important to diagnose this pathology as early as possible and to plan further optimal care of patients in order to minimize life-threatening complications. The aim of this study was to analyze the frequency of cases of invasive placenta, the peculiarities of their clinical manifestation in women who gave birth from 2006 to 2015, to evaluate diagnostic and treatment options of this pathology, and to review their changes when the level of services provided by the institution changes.
UNASSIGNED: A retrospective study was performed of the ten-year period of 2006 to 2015. The study consisted of examining the data of medical records of a group of 14 women.
UNASSIGNED: The incidence of invasive placenta at the secondary level hospital was 1/2170 births, 1:934 births at the tertiary level. There were only three patients (21.4%) diagnosed with invasive placenta during pregnancy at Vilnius University Hospital Santaros Klinikos Obstetrics and Gynaecology Centre. Before the surgery, pre-occlusive balloons were ushered into the internal iliac artery and inflated to reduce bleeding after the newborn delivery. The amount of blood loss in the whole group ranged from 1000 to 6500 ml (avg. 3130.7 ml). Radical treatment was given to eleven patients.
UNASSIGNED: Invasive placenta is a life-threatening condition. Tertiary-level hospitals have a greater capacity for antenatal diagnostics. Timely diagnosis of placental invasion and evaluation of the level of the myometrium damage before delivery is instrumental in planning patient care and preparing for delivery and operation.
UNASSIGNED: SantraukaĮvadas. Placentos invazija yra reta, bet motinos ir vaiko gyvybei pavojinga akušerinė patologija. Siekiant sumažinti gyvybei grėsmingų komplikacijų svarbu šios patologijos antenatalinė diagnostika ir tolimesnės optimalios pacienčių priežiūros planavimas. Šio tyrimo tikslas – išanalizuoti placentos invazijos atvejų dažnį, klinikinio pasireiškimo gimdžiusiųjų 2006–2015 m. ypatumus, įvertinti šios patologijos diagnostikos ir gydymo galimybes bei apžvelgti jų pokyčius, susijusius su medicinos įstaigos teikiamų paslaugų lygiu.Medžiaga ir metodai. Atliktas retrospektyvinis tyrimas, kurio metu išnagrinėti medicininės dokumentacijos duomenys ir atlikta jų analizė. Tyrime dalyvavo 14 pacienčių, kurios gimdė VUL SK nuo 2006 iki 2015 m. ir kurioms buvo kliniškai diagnozuota bei histologiškai patvirtinta invazinės placentos diagnozė.Rezultatai. Placentos invazijos dažnis antrinio lygio stacionare buvo 1 : 2170 gimdymų, tretinio lygio stacionare – 1 : 934 gimdymai. Tik trims pacientėms iš visos grupės (21,4 %) placentos invazija nustatyta VUL SK AGC iki gimdymo. Siekiant sumažinti kraujavimą operacijos metu, prieš operaciją į a. iliaca interna gali būti įvesti preokliuziniai balionėliai, kurie išpučiami gimus naujagimiui. Kraujo netekimas visoje grupėje svyravo nuo 1 000 iki 6 500 ml (vid. 3 130,7 ml). Vienuolika pacienčių buvo gydomos radikaliai.Išvados. Placentos invazija yra gyvybei pavojinga būklė. Tretinio lygio ligoninė turi geresnes antenatalinės diagnostikos galimybes. Ankstyva placentos invazijos diagnostika ir miometro pažeidimo įvertinimas prieš gimdymą lemia galimybę tinkamai suplanuoti pacientės priežiūrą ir pasiruošimą gimdymui bei operacijai.Raktažodžiai: kraujavimas po gimdymo, gimdos randas, histerektomija, placentos invazija.

There is concern about the risk of uterine rupture in the subsequent pregnancy after myomectomy. This risk is reported in literature to be around 0.7-1%. The aim of this study was to evaluate the incidence of uterine rupture and associated risk factors in women who had a trial of labor after prior myomectomy.
A systematic review of the literature was performed including all cohort studies with at least five cases reporting outcomes of pregnancies after prior myomectomy. The terms \"myomectomy\", \"pregnancy\", \"trial of labor\" and \"uterine rupture\" were used in PubMed and EMBASE searches for identification purposes. Every reference was reviewed for possible inclusion and all eligible cases of uterine rupture were considered.
Twenty-three studies with at least five cases of pregnancy after myomectomy were identified, with an overall incidence of uterine rupture of 0.6% (0.3-1.1%) (n = 11/1825). Of these 23 studies, 11 studies reported detailed data about trial of labor after myomectomy and related pregnancy outcomes, including 1034 pregnancies and 756 viable (≥24 weeks) deliveries. The overall incidence of uterine rupture after myomectomy in the included studies was 0.93% (0.45-1.92%) (n = 7/756); specifically, it was 0.47% (0.13-1.70%) (n = 2/426) in women undergoing trial of labor after myomectomy, and 1.52% (0.65-3.51%) (n = 5/330) in women before the onset of labor. Of the seven uterine ruptures, five (71%) occurred within 36 weeks (range 24-40 weeks).
Trial of labor after myomectomy is associated with a 0.47% risk of uterine rupture. There were no identified risk factors among the variables studied. The present systematic review of the literature revealed that uterine rupture after prior myomectomy occurred mainly before 36 weeks and before labor.

OBJECTIVE: The aim of this systematic review and metaanalysis was to determine the efficacy and safety of cervical ripening agents in the second trimester of pregnancy in patients with previous cesarean delivery.
METHODS: Data sources were PubMed, EMBASE, CINAHL, LILACS, Google Scholar, and clinicaltrials.gov (1983 through 2015). Eligibility criteria were cohort or cross-sectional studies that reported on efficacy and safety of cervical ripening agents in patients with previous cesarean delivery. Efficacy was determined based on the proportion of patients achieving vaginal delivery and vaginal delivery within 24 hours following administration of a cervical ripening agent. Safety was assessed by the risk of uterine rupture and complications such as retained placental products, blood transfusion requirement, and endometritis, when available, as secondary outcomes. Of the 176 studies identified, 38 met the inclusion criteria. Of these, 17 studies were descriptive and 21 studies compared the efficacy and safety of cervical ripening agents between patients with previous cesarean and those with no previous cesarean. From included studies, we abstracted data on cervical ripening agents and estimated the pooled risk differences and risk ratios with 95% confidence intervals. To account for between-study heterogeneity, we estimated risk ratios based on underlying random effects analyses. Publication bias was assessed via funnel plots and across-study heterogeneity was assessed based on the I(2) measure.
RESULTS: The most commonly used agent was PGE1. In descriptive studies, PGE1 was associated with a vaginal delivery rate of 96.8%, of which 76.3% occurred within 24 hours, uterine rupture in 0.8%, retained placenta in 10.8%, and endometritis in 3.9% in patients with ≥1 cesarean. In comparative studies, the use of PGE1, PGE2, and mechanical methods (laminaria and dilation and curettage) were equally efficacious in achieving vaginal delivery between patients with and without prior cesarean (risk ratio, 0.99, and 95% confidence interval, 0.98-1.00; risk ratio, 1.00, and 95% confidence interval, 0.98-1.02; and risk ratio, 1.00, and 95% confidence interval, 0.98-1.01; respectively). In patients with history of ≥1 cesarean the use of PGE1 was associated with higher risk of uterine rupture (risk ratio, 6.57; 95% confidence interval, 2.21-19.52) and retained placenta (risk ratio, 1.21; 95% confidence interval, 1.03-1.43) compared to women without a prior cesarean. However, the risk of uterine rupture among women with history of only 1 cesarean (0.47%) was not statistically significant (risk ratio, 2.36; 95% confidence interval, 0.39-14.32), whereas among those with history of ≥2 cesareans (2.5%) was increased as compared to those with no previous cesarean (0.08%) (risk ratio, 17.55; 95% confidence interval, 3.00-102.8). Funnel plots did not demonstrate any clear evidence of publication bias. Across-study heterogeneity ranged from 0-81%.
CONCLUSIONS: This systematic review and metaanalysis provides evidence that PGE1, PGE2, and mechanical methods are efficacious for achieving vaginal delivery in women with previous cesarean delivery. The use of prostaglandin PGE1 in the second trimester was not associated with significantly increased risk for uterine rupture among women with only 1 cesarean; however, this risk was substantially increased among women with ≥2 cesareans although the absolute risk appeared to be relatively small.