Cesarean Section Versus Vaginal Delivery

Dear Colleagues,

Although the processes of labor and birth have existed since the emergence of animal and then human species, recent years have brought significant technical advancements aimed at ensuring safer deliveries.

With respect to vaginal birth, new labor induction methods have been developed to reduce the rate of cesarean sections. Cervical ripening techniques have diversified, ranging from the Foley catheter and Cook balloon to prostaglandin administration and laminaria insertion, each with its own advantages and limitations.

Ultrasound has become an increasingly valuable tool, both in assessing cervical readiness through elastography (offering a more objective alternative to the Bishop score) and in evaluating labor progression. Dynamic parameters such as the angle of progression, head–perineum distance, and fetal position can help estimate the likelihood of successful vaginal delivery or the need for cesarean section.

Ultrasound can also detect intrapartum trauma and assess uterine scar quality, contributing to the risk stratification of uterine rupture and guiding the decision against TOLAC (Trial of Labor After Cesarean). Furthermore, it plays a role in identifying placental adhesion abnormalities, with MRI serving as a second-line investigation when needed.

These objective evaluations, which replace traditional clinical assessments with quantifiable parameters, may lay the groundwork for AI-assisted labor monitoring.

Indications for cesarean delivery have evolved as well. Some are now applied excessively, often due to medicolegal concerns. Thus, malpractice related to labor and delivery management is also a relevant theme for this Special Issue.

Neonatal outcomes following vaginal births—either spontaneous or assisted—versus cesarean delivery merit further investigation, as do the criteria for labor induction and cesarean indication in specific clinical scenarios such as previous uterine surgery, fetal growth restriction, abnormal presentations, placenta accreta spectrum, and vasa previa.

Cesarean birth has also been shown to alter fetal and neonatal microbiota when compared to vaginal delivery, with medium- and long-term health consequences that are still not fully understood.

Psychological changes induced by childbirth and their subsequent effects over time represent another important topic worthy of further exploration.

Submissions of original research, comprehensive reviews, and related works on these topics are welcomed for inclusion in this Special Issue.

Dr. Demetra Gabriela Socolov
Dr. Angela Vinturache
Prof. Dr. Liana Ples
Guest Editors

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• cesarean section
• vaginal delivery
• birth outcomes
• birth complications
• delivery mode
• labor process
• obstetric care
• trial of labor after cesarean (TOLAC)
• intrapartum care
• obstetric decision-making