Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries

Abstract

Objective: To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings.

Design: A prospective 4-year observational study.

Setting: Senegal and Mali.

Sample: A cohort of 9712 women with one previous caesarean delivery.

Methods: Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics.

Main outcome measures: The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors.

Conclusion: Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors.

Tweetable abstract: Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.

Keywords: Elective repeated caesarean section; perinatal and maternal outcomes low-resource setting; sub-Saharan Africa; trial of labour; vaginal birth after caesarean section.