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Trial of labour after caesarean section in sub‐Saharan Africa: ameta‐analysis
Author(s) -
Boulvain Michel,
Fraser William D.,
BrissonCarroll Gisèle,
Faron Gilles,
Wallast Elizabeth
Publication year - 1997
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1997.tb11008.x
Subject(s) - caesarean section , vaginal delivery , medicine , context (archaeology) , uterine rupture , obstetrics , labour ward , pregnancy , geography , genetics , archaeology , uterus , biology
Objective To evaluate the safety and effectiveness of apolicy of trial of labour for women with a previous caes are an section, delivering in hospitals in sub‐Saharan Africa. Design Ameta‐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 condition swere 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% CI63–75%). Maternal mortality among all women with aprevious caesarean section was 1.9/1000 (95%CI0–4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95%CI1.0–3.2). Criteria used to select women foratrial 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.