Transactions of the Twentieth Annual Meeting of the Society for Maternal-Fetal MedicineElective repeat cesarean delivery versus trial of labor: A meta-analysis of the literature from 1989 to 1999☆
Section snippets
Material and methods
We identified relevant studies through a computer search of English-language abstracts in the MEDLINE and EMBASE databases for the years 1989 and 1999. We also searched the registry of clinical trials maintained by the Cochrane Pregnancy and Childbirth Group. A variety of searches were conducted with combinations of the following medical subject heading terms: vaginal birth after cesarean, trial of labor, trial of scar, and uterine rupture. We supplemented our search by cross-checking the
Results
All included studies provided information about probability of successful vaginal birth among women undergoing a trial of labor. Across the 15 studies a total of 28,813 women underwent a trial of labor, and 20,746 achieved successful vaginal birth (weighted average 72.3%; 95% confidence interval, 71.8%-72.8%).
Eleven studies that contained a total of 39,116 women*examined the risk of uterine rupture for a trial of labor compared with elective
Comment
Our analyses suggest that symptomatic uterine rupture, the most feared complication among women with previous cesarean delivery, may be about twice as common among women undertaking a trial of labor than among women undergoing elective repeat cesarean delivery. The absolute risk of this outcome remains low, however, and it is not nil even with a policy of elective repeat cesarean delivery. According to the odds ratios computed in our analysis, between 374 and 809 women would need to undergo
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