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Meta-Analysis
. 2013 Dec 10;2013(12):CD004224.
doi: 10.1002/14651858.CD004224.pub3.

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

Jodie M Dodd  1 , Caroline A Crowther, Erasmo Huertas, Jeanne-Marie Guise, Dell Horey
Affiliations
Meta-Analysis

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

Jodie M Dodd et al. Cochrane Database Syst Rev. .

Abstract

Background: When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. While there are risks and benefits for both planned elective repeat caesarean birth and planned vaginal birth after caesarean (VBAC), current sources of information are limited to non-randomised cohort studies. Studies designed in this way have significant potential for bias and consequently conclusions based on these results are limited in their reliability and should be interpreted with caution.

Objectives: To assess, using the best available evidence, the benefits and harms of a policy of planned elective repeat caesarean section with a policy of planned VBAC for women with a previous caesarean birth.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013) and reference lists of retrieved studies.

Selection criteria: Randomised controlled trials with reported data that compared outcomes in mothers and babies who planned a repeat elective caesarean section with outcomes in women who planned a vaginal birth, where a previous birth had been by caesarean.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data.

Main results: Two randomised trials involving 320 women and their infants were included. However, data for maternal and infant clinical outcomes were available from one trial with very low event rates, involving 22 women only.For the primary outcomes maternal death or serious morbidity (one study; 22 women; risk ratio (RR) not estimable), and infant death or serious morbidity (one study; 22 women; RR not estimable), there were no statistically significant differences between planned caesarean birth and planned vaginal birth identified.

Authors' conclusions: Planned elective repeat caesarean section and planned VBAC for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is largely drawn from non-randomised studies, associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned vaginal birth for women with a previous caesarean birth.

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Conflict of interest statement

Jodie Dodd and Caroline Crowther are the authors of one of the reports included in this review. This study report was assessed by the other authors.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Primary outcome, Outcome 1 Death or serious maternal morbidity.
1.2
1.2. Analysis
Comparison 1 Primary outcome, Outcome 2 Death or serious infant morbidity.
2.1
2.1. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 1 Vaginal birth.
2.2
2.2. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 2 Caesarean section.
2.3
2.3. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 3 Uterine rupture.
2.4
2.4. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 4 Haemorrhage or need for blood transfusion.
2.5
2.5. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 5 Hysterectomy.
2.6
2.6. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 6 Vulval or perineal haematoma.
2.7
2.7. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 7 Deep vein thrombosis.
2.8
2.8. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 8 Pulmonary embolus.
2.9
2.9. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 9 Pneumonia.
2.10
2.10. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 10 Adult respiratory distress syndrome.
2.11
2.11. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 11 Wound Infection.
2.12
2.12. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 12 Wound dehiscence.
2.13
2.13. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 13 Organ damage.
2.14
2.14. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 14 Development of fistula.
2.15
2.15. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 15 Bowel obstruction.
2.16
2.16. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 16 Pulmonary oedema.
2.17
2.17. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 17 Stroke.
2.18
2.18. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 18 Cardiac arrest.
2.19
2.19. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 19 Respiratory arrest.
2.20
2.20. Analysis
Comparison 2 Secondary maternal outcomes, Outcome 20 Maternal death.
3.1
3.1. Analysis
Comparison 3 Secondary infant outcomes, Outcome 1 Perinatal death.
3.2
3.2. Analysis
Comparison 3 Secondary infant outcomes, Outcome 2 Apgar score less than 7 at 5 minutes.
3.3
3.3. Analysis
Comparison 3 Secondary infant outcomes, Outcome 3 Birthweight.
3.4
3.4. Analysis
Comparison 3 Secondary infant outcomes, Outcome 4 Intensive care unit admission.
3.5
3.5. Analysis
Comparison 3 Secondary infant outcomes, Outcome 5 Birth trauma.
3.6
3.6. Analysis
Comparison 3 Secondary infant outcomes, Outcome 6 Seizures.
3.7
3.7. Analysis
Comparison 3 Secondary infant outcomes, Outcome 7 Neonatal encephalopathy.
3.8
3.8. Analysis
Comparison 3 Secondary infant outcomes, Outcome 8 Severe respiratory distress syndrome.
3.9
3.9. Analysis
Comparison 3 Secondary infant outcomes, Outcome 9 Necrotising enterocolitis.
3.10
3.10. Analysis
Comparison 3 Secondary infant outcomes, Outcome 10 Systemic infection.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Crowther 2012b {published data only}
    1. Crowther C, Dodd J, Haslam R, Hiller J. BAC ‐ Birth after caesarean: planned vaginal birth or planned elective repeat caesarean for women at term with a single previous caesarean section. Perinatal Society of Australia and New Zealand (www.psanz.org.au) (accessed 4 October 2006).
    1. Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS. Planned repeat elective caesarean section after previous caesarean section compared with planned vaginal birth is associated with improved health outcomes for women and their infants. Journal of Paediatrics and Child Health 2011;47(Suppl 1):36.
    1. Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS, Birth After Caesarean Study Group. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial. PLoS Medicine 2012;9(3):e1001192. - PMC - PubMed
    1. Dodd JM, Crowther CA, Hiller JE, Haslam RR, Robinson JS. Birth after caesarean study‐‐planned vaginal birth or planned elective repeat caesarean for women at term with a single previous caesarean birth: protocol for a patient preference study and randomised trial. BMC Pregnancy and Childbirth 2007;7:17. - PMC - PubMed
Law 2010 {published data only}
    1. Chung T, Law LW, Pang MW, Lau TK. VBAC versus caesarean section: a randomised controlled trial on psychological outcomes. BJOG: an international journal of obstetrics and gynaecology 2008;115(s1):80.
    1. Law LW, Pang MW, Chung TK, Lao TT, Lee DT, Leung TY, et al. Randomised trial of assigned mode of delivery after a previous cesarean section‐‐impact on maternal psychological dynamics. Journal of Maternal‐Fetal & Neonatal Medicine 2010;23(10):1106‐13. - PubMed

Additional references

ACOG 2010
    1. American College of Obstetricians and Gynecologists (ACOG). Vaginal Birth after Previous Cesarean Delivery (ACOG Practice Bulletin; no 115). Washington DC: ACOG, 2010.
Belizan 1999
    1. Belizan J, Althabe F, Barros F, Alexander S. Rates and implication of cesarean sections in Latin America: ecological study. BMJ 1999;319:1397‐402. - PMC - PubMed
CDC 2010
    1. Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Wilson EC, Mathews TJ. Births: Final Data for 2010. http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf#table02 (accessed June 2013). - PubMed
Crowther 2012a
    1. Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS, Birth After Caesarean Study Group. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial. PLoS Medicine 2012;9(3):e1001192. - PMC - PubMed
Guise 2010
    1. Guise J‐M, Eden K, Emeis C, Denman M, Marshall N, Fu R, et al. Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment No. 191. (Prepared by the Oregon Health & Science University Evidence‐based Practice Center for the 2010 NIH Consensus Conference. http://www.ahrq.gov/clinic/tp/vbacuptp.htmMarch 2010under Contract No. 290‐2007‐10057‐I.) AHRQ Publication No. 10‐E001. Rockville, MD: Agency for Healthcare Research and Quality; March 2010.
Hamilton 2012
    1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary Data for 2011. http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05.pdf 2012 (accessed January 3, 2013). - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hook 1997
    1. Hook B, Kiwi R, Amini SB, Fanaroff A, Hack M. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 1997;100(3 Pt 1):348‐53. - PubMed
Landon 2004
    1. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. New England Journal of Medicine 2004;351:2581‐9. - PubMed
Marshall 2011
    1. Marshall N, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. American Journal of Obstetrics and Gynecology 2011;205(3):262.e1‐8. - PubMed
Mastrobattista 1999
    1. Mastrobattista JM. Vaginal birth after cesarean delivery. Obstetrics and Gynecology Clinics of North America 1999;26(2):295‐304. - PubMed
Morrison 1995
    1. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. British Journal of Obstetrics and Gynaecology 1995;102(2):101‐6. - PubMed
NICE 2004
    1. NICE. Caesarean Section. Clinical Guideline. London: RCOG, 2004 April.
OECD Health Data 2011
    1. OECD. Caesarean Sections. http://www.oecd‐ilibrary.org/sites/health_glance‐2011‐en/04/09/index.html;jsessionid=as0... (accessed 2013).
RCOG 2001
    1. RCOG Clinical Effectiveness Support Unit. The Sentinel National Caesarean Section Audit Report. RCOG Press 2001.
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.

References to other published versions of this review

Dodd 2004
    1. Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD004224.pub2] - DOI - PubMed

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