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Trial of labour after caesarean section in sub-Saharan Africa: a meta-analysis
M Boulvain1, W D Fraser, G Brisson-Carroll
1Centre Hospitalier Universitaire de Québec, Canada.
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.