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Dergiler / İstanbul Tıp Fakültesi Dergisi / 2026 / Cilt: 89 Sayı: 3

Trial of labor after cesarean and vaginal birth after cesarean section in Türkiye: According to the national clinical protocol, how applicable is it?

Selim Büyükkurt(Çukurova Üniversitesi)0000-0003-0572-254X
Sayfa
231–235
Yayın Tarihi
2026-08-14
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⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Based on current evidence, there is a clear need to revise the national protocol in Türkiye to ensure alignment with up-to-date scientific data and to promote balanced, evidence-based decision-making in TOLAC/VBAC practice.

📌 3 Maddede Bu Makale

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Amaç & Hipotez:This review evaluates the applicability of trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC) in Türkiye within the framework of the national clinical protocol, in comparison with contemporary international guidelines.
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Temel Bulgular & Veri:Over the past half-century, increasing medicalization of childbirth and widespread use of fetal monitoring have contributed to a substantial rise in cesarean section (CS) rates, without a proportional reduction in perinatal mortality or cerebral palsy.
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Sonuç & Katkı:Based on current evidence, there is a clear need to revise the national protocol in Türkiye to ensure alignment with up-to-date scientific data and to promote balanced, evidence-based decision-making in TOLAC/VBAC practice.
🔬Tür:Literatür & Derleme Çalışması
📍Kapsam:Genişletilmiş Akademik Örneklem
⚙️Değişkenler:Trial of labor after cesarean · vaginal birth after cesarean delivery · cesarean section

Abstract

This review evaluates the applicability of trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC) in Türkiye within the framework of the national clinical protocol, in comparison with contemporary international guidelines. Over the past half-century, increasing medicalization of childbirth and widespread use of fetal monitoring have contributed to a substantial rise in cesarean section (CS) rates, without a proportional reduction in perinatal mortality or cerebral palsy. Türkiye remains among the countries with the highest CS rates, with Robson groups involving previous cesarean deliveries (groups 5 and 10) representing a major contribution. International evidence indicates that, in appropriately selected cases, TOLAC achieves a success rate of 60–80% and is associated with a low risk of uterine rupture. Current guidelines from American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and International Federation of Gynecology and Obstetrics define TOLAC as a reasonable option that should be offered to most women with a prior cesarean. In contrast, the Turkish national protocol appears more restrictive and defensive, including contraindications and risk estimates that are not consistently aligned with the literature and supported by limited or outdated references. Additionally, institutional requirements for offering TOLAC are defined more stringently than in comparable guidelines. Considering the association between rising CS rates and long-term maternal and obstetric complications, strategies aimed at reducing both primary and repeat cesareans are essential. Based on current evidence, there is a clear need to revise the national protocol in Türkiye to ensure alignment with up-to-date scientific data and to promote balanced, evidence-based decision-making in TOLAC/VBAC practice.

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Bu Makaleye Atıf Yap

Büyükkurt, S. (2026). Trial of labor after cesarean and vaginal birth after cesarean section in Türkiye: According to the national clinical protocol, how applicable is it?. İstanbul Tıp Fakültesi Dergisi, Cilt: 89 Sayı: 3, 231–235. https://doi.org/10.26650/IUITFD.1889391

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Kaynakça (35)

  1. Loudon I. General practitioners and obstetrics: A brief history. J R Soc Med 2008;101(11):531-5. google scholar
  2. Ozaydin Z, Hot AG. Dr. Besim Omer Paşa’nin ülkemiz nüfus siyaseti hakkindaki görüşleri [Dr. Besim Omer Akalin and population policy in Turkey]. Tip Tarihi Arastirmalari 1999;9:215-20. google scholar
  3. Neutra RR, Greenland S, Friedman EA. Effect of fetal monitoring on cesarean section rates. Obstet Gynecol 1980;55(2):175-80. google scholar
  4. Sartwelle TP, Johnston JC, Arda B. A half century of electronic fetal monitoring and bioethics: silence speaks louder than words. Matern Health Neonatol Perinatol 2017;3:21. google scholar
  5. Boehm FH, Davidson KK, Barrett JM. The effect of electronic fetal monitoring on the incidence of cesarean section. Am J Obstet Gynecol 1981;140(3):295-8. google scholar
  6. National Library of Medicine. Cesarean Section– A Brief History. Accessed February 3, 2026. https://neonatology.net/pdf/cesarean.pdf google scholar
  7. Nelson KB. Can we prevent cerebral palsy? N Engl J Med 2003;349(18):1765-9. google scholar
  8. McIntyre S, Goldsmith S, Webb A, Ehlinger V, Hollung SJ, McConnell K, et al. Global prevalence of cerebral palsy: A systematic analysis. Dev Med Child Neurol 2022;64(12):1494-506. google scholar
  9. Jha S. The Story of Electronic Fetal Monitoring – A Cautionary Tale for Radiologists. Academic Radiology 2025;32 (Suppl 1):S159-62. google scholar
  10. World Health Organization. WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO google scholar
  11. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021;6(6):e005671. google scholar
  12. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/births-by-caesarean-section-(-) (Accessed February 3, 2026) google scholar
  13. Ulgu MM, Birinci S, Ensari TA, Gözükara MG. Cesarean section rates in Turkey 2018-2023: Overview of national data by using Robson ten group classification system. Turk J Obstet Gynecol 2023;20(3):191-8. google scholar
  14. Bruno A, Allshouse A, Metz T. Trends in attempted and successful trial of labor after cesarean delivery in the United States from 2010 to 2020. Obstet Gynecol 2023;141(1):173-5. google scholar
  15. Sezaryen sonrası vaginal doğum (SSVD) klinik protokolü. T.C. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Araştırma, Geliştirme ve Sağlık Teknolojisi Değerlendirme Daire Başkanlığı. Ankara – 2024. (Accessed February 3, 2026) https://dosyamerkez.saglik.gov.tr/Eklenti/49483/0/ssvdkp16102024pdf.pdf google scholar
  16. Nieto-Calvache AJ, Ramasauskaite D, Palacios-Jaraquemada JM, Hussein AM, Jauniaux E, Ubom AEB, et al. Complex cesarean section: Surgical approach to reduce the risks of intraoperative complications and postpartum hemorrhage. Int J Gynecol Obstet 2025;168:987-98. google scholar
  17. Civelek M, Büyükkurt S, Yılmaz MB, Erdoğan K, Öksüz H, Avcı Ç, et al. Early histopathological comparison of single versus double-layer closure of uterine incision during cesarean: A controlled study in rats. Journal of Istanbul Faculty of Medicine 2023;86(3):220-6. google scholar
  18. Menacker F, Declercq E, Macdorman MF. Cesarean delivery: background, trends, and epidemiology. Semin Perinatol 2006;30:235-41. google scholar
  19. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S, et al. Births: final data for 2006. Natl Vital Stat Rep 2009;57(7):1–104. google scholar
  20. National Institutes of Health Consensus Development conference statement: vaginal birth after cesarean: new insights March 8–10, 2010. Obstet Gynecol 2010;115:1279–95. google scholar
  21. ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstet Gynecol 2019;133(2):e110-27. google scholar
  22. Di Spiezio Sardo A, Saccone G, McCurdy R, Bujold E, Bifulco G, Berghella V. Risk of cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol 2017;50:578-83. google scholar
  23. Bujold E, Dubé E, Girard M, Chaillet N. Lower uterine segment thickness to predict uterine rupture: a secondary analysis of PRISMA cluster randomized trial. Am J Obstet Gynecol MFM 2024;6(12):101543. google scholar
  24. Dodd JM, Anderson ER, Gates S, Grivell RM. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev 2014(7):CD004732. google scholar
  25. McLeish SF, Murchison AB, Smith DM, Ghahremani T, Johnson IM, Magann EF. Predicting uterine rupture risk using lower uterine segment measurement during pregnancy with cesarean history: How reliable is it? A Review. Obstet Gynecol Surv 2023;78(5):302-8. google scholar
  26. Maheux-Lacroix S, Bujold E. Hysterotomy closure at cesarean: beyond the number of layers. Am J Obstet Gynecol 2024;231(1):e44. google scholar
  27. Royal College of Obctetricians Gynecologist, Birth After Previous Caesarean Birth, Green-top Guidline No.45, October 2015. Accessed February 3, 2026. https://www.rcog.org.uk/media/kpkjwd5h/gtg_45.pdf google scholar
  28. Barnea ER, Ramasauskaite D, Ubom AE, Di Simone N, Mueller M, Borovac-Pinheiro A, et al and FIGO Childbirth and Postpartum Hemorrhage Committee. FIGO good practice recommendations for vaginal birth after cesarean section. Int J Gynecol Obstet 2025;171:17-31. google scholar
  29. Landon MB, Grobman WA. Vaginal birth after cesarean section. In: Landon, Galan, Jauniaux, Driscoll, Berghella, Grobman, Kilpatrick, Cahill editors. Gabbe’s Obstetrics Normal and Problem Pregnancies 8th Edition, 2021. Philadelphia. Elsevier. 398-400. google scholar
  30. Didier-Mathon H, Kayem G, Thubert T, Sentilhes L, Garabedian C, Schmitz T, et al. Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery. Acta Obstet Gynecol Scand. 2025;104(2):380-8. google scholar
  31. Nahum-Yerushalmy A, Walfisch A, Lipschuetz M, Rosenbloom JI, Kabiri D, Hochler H. Uterine rupture risk in a trial of labor after cesarean section with and without previous vaginal births. Arch Gynecol Obstet. 2022;305(6):1633-9. google scholar
  32. Zeitlin J, Durox M, Macfarlane A, Alexander S, Heller G, Loghi M, et al. Using Robson’s ten group classification system for comparing caesarean section rates in Europe: An analysis of routine data from the Euro-Peristat study. BJOG 2021;128:1444-53. google scholar
  33. Goodman LH, Allshouse AA, Metz TD, Bruno AM. Uterine rupture trends in patients pursuing trial of labor after cesarean in the United States from 2010 to 2022. Obstet Gynecol 2025;145(5):511-3. google scholar
  34. Amikam U, Hochberg A, Segal R, Abramov S, Lavie A, Yogev Y, et al. Perinatal outcomes following uterine rupture during a trial of labor after cesarean: A 12-year single-center experience. Int J Gynaecol Obstet 2024;165(1):237-43. google scholar
  35. Bruno AM, Allshouse AA, Metz TD. Trends in attempted and successful trial of labor after cesarean delivery in the United States From 2010 to 2020. Obstet Gynecol 2023;141(1):173-5. google scholar