title: Trial of labour after caesarean section in sub-Saharan Africa: a meta-analysis.
abstract: 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.
  
  
  METHODS
  A meta-analysis of 17 published reports.
  
  
  METHODS
  Hospitals located in sub-Saharan Africa.
  
  
  METHODS
  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.
authors.affiliation: Centre Hospitalier Universitaire de Québec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Boulvain
authors.forename: W D
authors.initials: WD
authors.lastname: Fraser
authors.forename: G
authors.initials: G
authors.lastname: Brisson-Carroll
authors.forename: G
authors.initials: G
authors.lastname: Faron
authors.forename: E
authors.initials: E
authors.lastname: Wollast
mesh_terms: D017954:Africa South of the Sahara; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean