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