The uterine scar dilemma: Outcomes of a restricted elective repeat cesarean section policy in a high-fertility, resource-limited setting

2026-07-06

Raffaela Baiocchi *

Giovanni Di Lorenzo

Keren Picucci

Laura Lamparelli

Khatera Wafa

Rabila Wafa

Najla Amiri

Sonia Saiedi

Mitra Omery

Tania Sayad

Spozhmai Asadzoi

Elena Magni

Giulia Butera

Davide De Santo

Federico Romano

Giuseppe Ricci

Martin Langer

DOI：10.1111/aogs.70219

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The global increase in cesarean section (CS) rates poses particular challenges in low- and middle-income countries (LMICs). In high-fertility, resource-limited settings, deciding the optimal mode of delivery for women with a uterine scar is complex. Elective repeat CS (ERCS) is often preferred over trial of labor after cesarean (TOLAC), despite limited evidence on its safety and feasibility. This study aimed to describe clinical management and birth outcomes among women with prior cesarean section managed under a restricted ERCS policy and to identify prognostic factors to inform delivery decisions.

Keywords:

Afghanistan

cesarean section

low- and middle-income countries

maternal outcomes

neonatal outcomes

trial of labor after cesarean

vaginal delivery after cesarean

The uterine scar dilemma: Outcomes of a restricted elective repeat cesarean section policy in a high-fertility, resource-limited setting

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