Assessing the Influence of Absent Vaginal Birth on Non - Descent vaginal hysterectomy (NDVH): A Retrospective comparative Analysis of NDVH outcomes in women with prior vaginal Birth versus women with absent vaginal Birth

Background: Numerous alleged contraindications limit the adoption of Non-Descent Vaginal Hysterectomy (NDVH), notably the absence of prior vaginal birth (NPVB). This study investigates whether this holds true.Aim: To compare NDVH success rates and perioperative outcomes in women with and without PVB.Patients and Methods: This retrospective cohort study included 1,540 women who underwent NDVH between 2008 and 2025 at a university hospital and affiliated centers.Results: Of 1,540 patients, 694 (45%) were NPVB (reference group)—330 (47.56%) nulliparous and 364 (52.44%) cesarean-only (CSO); 846 (55%) had ≥1PVB—350 (41.66%) vaginal-only birth (VBO) and 496 (59.04%) mixed vaginal/cesarean (MC/VB) (investigational group). Both groups were comparable in baseline characteristics, with no significant differences in perioperative complications, transfusion rates, visceral injuries, infections, or conversion to total abdominal hysterectomy (TAH) (p > 0.05). NDVH was completed in 98.18% of nulliparas, 98.62% of CSO, and 98.41% of all NPVB cases. Similarly, ≥1PVB women had high success rates: 99.42% in VBO, 98.80% in MC/VB, and 99.06% overall. However, conversion to TAH significantly increased with higher-order cesareans: ≥3 CSs (RR = 4.45) and ≥4 CSs (RR = 8.05) in CSO; RR = 3.32 and 4.24 in MC/VB. Among nulliparas with prior hysterotomy or abdominal surgery, RR rose to 12.57 and 12.18, respectively. In contrast, uterine weight <280g in ≥1PVB was protective (RR = 0.27).Conclusion: NDVH is safe and effective regardless of PVB status. Mere APVB in nulliparous or CSO women should not preclude NDVH, and the necessity of laparoscopy in such cases should be reconsidered.