title: Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries.
abstract: 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.
  
  
  
  A prospective 4-year observational study.
  
  
  
  Senegal and Mali.
  
  
  
  A cohort of 9712 women with one previous caesarean delivery.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors.
  
  
  
  Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.
authors.affiliation: Research Institute for Development, Paris Descartes and Sorbonne Universities, Paris, France.|Health Sciences Research Institute, Ouagadougou, Burkina Faso.
authors.forename: C
authors.initials: C
authors.lastname: Kaboré
authors.affiliation: Department of Obstetrics and Gynaecology, University of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Chaillet
authors.affiliation: Health Sciences Research Institute, Ouagadougou, Burkina Faso.
authors.forename: S
authors.initials: S
authors.lastname: Kouanda
authors.affiliation: Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Bujold
authors.affiliation: URFOSAME, Referral Health Centee of the Commune V, Bamako, Mali.
authors.forename: M
authors.initials: M
authors.lastname: Traoré
authors.affiliation: Research Institute for Development, Paris Descartes and Sorbonne Universities, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Dumont
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008302:Mali / Q000453:epidemiology; D016017:Odds Ratio; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D012675:Senegal / Q000453:epidemiology; D014219:Trial of Labor; D014597:Uterine Rupture / Q000209:etiology / Q000401:mortality; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
keywords: Elective repeated caesarean section; perinatal and maternal outcomes low-resource setting; sub-Saharan Africa; trial of labour; vaginal birth after caesarean section