{"id":5447,"date":"2020-05-27T20:04:08","date_gmt":"2020-05-27T18:04:08","guid":{"rendered":"https:\/\/choosingwiselyitaly.org\/?post_type=raccomandazione-prof&#038;p=5447"},"modified":"2020-05-28T18:56:29","modified_gmt":"2020-05-28T16:56:29","slug":"dont-schedule-routine-repeated-cesarean-section-cs-in-all-the-pregnant-women-with-a-previous-cesarean-section","status":"publish","type":"raccomandazione-prof","link":"https:\/\/choosingwiselyitaly.org\/en\/raccomandazione-prof\/dont-schedule-routine-repeated-cesarean-section-cs-in-all-the-pregnant-women-with-a-previous-cesarean-section\/","title":{"rendered":"Don\u2019t schedule routine repeated cesarean section (CS) in all the pregnant women with a previous cesarean section."},"content":{"rendered":"<p>The general rule \u201conce a cesarean always cesarean\u201d is not based on scientific evidence. Scientific societies suggest the admission to labour for pregnant women with a history of a previous CS if there are not contraindications and in the setting where emergency CS is available.<br \/>\nTolac (Trial Of Labour After Cesarean) is associated to a slight increased risk of uterine scar rupture (this risk is estimated to be approximately 47 cases over 10.000). Neonatal mortality following uterine rupture is a rare event in the reference centres (1:10.000) whereas in the birth settings not adequately equipped may reach 1.000- 2.500 cases over 10.000. Pregnant women with a previous CS admitted to labour of delivery have a lower mortality risk (3-4:100.000) than women undergoing a scheduled CS (13.4:100.000). Elective repeated cesarean section is associated to a higher blood loss, surgical complications and placental anomalies in the future pregnancies.<br \/>\nUltimately the available scientific studies consider the admission to a vaginal delivery for women with a previous CS to be advantageous if the selection criteria are met and the place of birth is equipped for a safe emergency cesarean section.<\/p>\n","protected":false},"featured_media":4583,"template":"","meta":{"_wpml_word_count":["{\"total\":302,\"to_translate\":{\"it\":302}}"],"_wpv_contains_gutenberg_views":[""],"_layouts_template":["modello-per-raccomandazioni-professionista"],"_wp_page_template":["default"],"_edit_lock":["1590684999:2"],"_edit_last":["2"],"_wpml_media_featured":["1"],"_wpml_media_duplicate":["1"],"_wpml_location_migration_done":["1"],"_thumbnail_id":["4583"],"wpcf-pacchetto":["AOGOI #1"],"wpcf-bibliografia":["1.\tAmerican College of Obstetricians and Gynecologysts  ACOG Practice Bulletin No. 115 Vaginal birth after previous  cesarean. Obstet Gynecol.2010\r\n2.\tRoyal College of Obstetricians & Gynaecologists Birth After Previous Caesarean Birth. Green-top Guideline No. 45; October 2015\r\n3.\t Landon MB et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. 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