In recent years, with the adjustment of the "two-child" policy, the proportion of pregnant women with a history of cesarean section, myomectomy and uterine cavity surgery has increased significantly. How obstetricians respond and carry out scientific and standardized management has become the focus and difficulty of this field. First, the issue of vaginal birth after cesarean section (VBAC), a review article published in this journal three years ago[1]In the same period, the VBAC expert consensus was also published. In the past few years, we are pleased to see that the VBAC rate of some domestic hospitals has increased significantly; The two related articles published in this issue provide valuable clinical experience for further improving the domestic VBAC rate. Secondly, uterine rupture in pregnancy is another critical obstetric disease. Based on the study of "Dynamic Monitoring of Whole Pregnancy after Cesarean Section and Repregnancy" conducted by Peking University First Hospital, there is little correlation between the thickness of lower uterine segment (LUS) muscle layer in early pregnancy and uterine rupture. Only "thin lower uterine segment" or "small uterine scar defect" in early pregnancy does not need to terminate pregnancy, but for those with large uterine scar defect, LUS should be closely monitored by ultrasound. Qualitative analysis in the third trimester of pregnancy is more meaningful than quantitative measurement of LUS muscle thickness for suggesting uterine rupture. The results of this study are of great value to guide the pregnant with scar uterus. In addition, in recent years, there have been literature reports that in addition to scar uterus, uterine rupture in pregnancy will also occur after minimally invasive surgery. In this issue, data from a national multi-center retrospective survey showed that the uterine rupture rate of pregnant women with a history of obstetric and gynecological surgery without cesarean section was higher than that of those with a history of cesarean section, suggesting that obstetricians should be alert to early identification and treatment of uterine rupture without a history of cesarean section during pregnancy and intrapartum health care, so as to improve the prognosis of mother and child. Third, the impact of re-pregnancy with scar uterus, especially placental attachment with penetrating placenta implantation (placenta accreta spetrum, PAS) at the scar site of uterus after cesarean section, is also very severe, and it has become an important cause of postpartum bleeding, perinatal emergency hysterectomy and maternal death. In 2018, the International Federation of Obstetricians and Gynecologists (FIGO) and the American Association of Obstetricians and Gynecologists (ACOG) launched relevant guidelines[2,3]。 This issue explains the FIGO guidelines. How to make early diagnosis, assess the degree of disease, timely referral to superior medical institutions, and take individualized surgical treatment to effectively improve the pregnancy outcome, combined with the author's experience, is explained below.
