Objective To analyze the feasibility of vaginal delivery of scar uterus re-pregnancy in 46 cases after cesarean section, and to observe the influence on maternal and neonatal outcomes. Methods The clinical pregnancy data of 46 puerperae with scar uterus re-pregnancy after cesarean section who were admitted to the hospital were retrospectively analyzed. According to delivery mode, they were divided into vaginal birth after cesarean (VBAC) group (26 cases) and elective repeat cesarean section (ERCS) group (20 cases). The maternal transfusion rate, intrapartum hemorrhage, hospitalization time, hospitalization cost, neonatal weight, neonatal Apgar score and complications were compared between the two groups. Results The intrapartum hemorrhage, hospitalization time and hospitalization cost in VBAC group were less than those in ERCS group, while The neonatal weight and neonatal Apgar score were higher than those in ERCS group (P<0.05). There was no significant difference in maternal transfusion rate between VBAC group and ERCS group (3.85% vs 5.00%) (P>0.05). There was no uterine rupture in either groups. There was no significant difference in incidence of complication between VBAC group and ERCS group (7.69% vs 15.00%) (P>0.05). Conclusion The vaginal delivery feasibility of scar uterus re-pregnancy after cesarean section is relatively higher. It is safe and good, with low complications. It can effectively ensure the safety of mother and neonates and it can be promoted.