OBJECTIVE: To evaluate the safety and effectiveness of a policy of trial of labour for women with a previous caesarean section, delivering in hospitals in sub-Saharan Africa. DESIGN: A meta-analysis of 17 published reports. SETTING: Hospitals located in sub-Saharan Africa. MAIN OUTCOME MEASURES: The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical conditions were computed using an approach equivalent to a random effects model. RESULTS: The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI 63-75%). Maternal mortality among all women with a previous caesarean section was 1.9/1000 (95% CI 0-4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95% CI 1.0-3.2). Criteria used to select women for a trial of labour appeared to have a limited impact on the probability of vaginal delivery. CONCLUSIONS: In hospitals in sub-Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.
OBJECTIVE: To evaluate the safety and effectiveness of a policy of trial of labour for women with a previous caesarean section, delivering in hospitals in sub-Saharan Africa. DESIGN: A meta-analysis of 17 published reports. SETTING: Hospitals located in sub-Saharan Africa. MAIN OUTCOME MEASURES: The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical conditions were computed using an approach equivalent to a random effects model. RESULTS: The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI 63-75%). Maternal mortality among all women with a previous caesarean section was 1.9/1000 (95% CI 0-4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95% CI 1.0-3.2). Criteria used to select women for a trial of labour appeared to have a limited impact on the probability of vaginal delivery. CONCLUSIONS: In hospitals in sub-Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.
Authors: Richard Kalisa; Stephen Rulisa; Jos van Roosmalen; Thomas van den Akker Journal: BMC Pregnancy Childbirth Date: 2017-08-25 Impact factor: 3.007
Authors: Jodie M Dodd; Caroline A Crowther; Janet E Hiller; Ross R Haslam; Jeffrey S Robinson Journal: BMC Pregnancy Childbirth Date: 2007-08-14 Impact factor: 3.007