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Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis

BMC pregnancy and childbirth, 2019-12, Vol.19 (1), p.529-529, Article 529 [Peer Reviewed Journal]

2019. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;The Author(s). 2019 ;ISSN: 1471-2393 ;EISSN: 1471-2393 ;DOI: 10.1186/s12884-019-2689-5 ;PMID: 31888540

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  • Title:
    Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis
  • Author: Wingert, Aireen ; Hartling, Lisa ; Sebastianski, Meghan ; Johnson, Cydney ; Featherstone, Robin ; Vandermeer, Ben ; Wilson, R Douglas
  • Subjects: Abdominal surgery ; Childbirth & labor ; Gynecology ; Health risk assessment ; Influence ; Intervention ; Meta-analysis ; Morbidity ; Mortality ; Multiple births ; Systematic review ; Trial of labor after cesarean ; Vaginal birth after cesarean
  • Is Part Of: BMC pregnancy and childbirth, 2019-12, Vol.19 (1), p.529-529, Article 529
  • Description: To systematically review the literature on clinical interventions that influence vaginal birth after cesarean (VBAC) rates. We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by searching for clinical trial records, conference proceedings and dissertations. Limits were applied for language (English and French) and year of publication (1985 to present). Two reviewers independently screened comparative studies (randomized or non-randomized controlled trials, and observational designs) according to a priori eligibility criteria: women with prior cesarean sections; any clinical intervention or exposure intended to increase the VBAC rate; any comparator; and, outcomes reporting VBAC, uterine rupture and uterine dehiscence rates. One reviewer extracted data and a second reviewer verified for accuracy. Meta-analysis was conducted using Mantel-Haenszel (random effects model) relative risks (VBAC rate) and risk differences (uterine rupture and dehiscence). Two reviewers independently conducted methodological quality assessments using the Mixed Methods Appraisal Tool (MMAT). Twenty-nine studies (six trials and 23 cohorts) examined different clinical interventions affecting rates of vaginal deliveries among women with a prior cesarean delivery (CD). Methodological quality was good overall for the trials; however, concerns among the cohort studies regarding selection bias, comparability of groups and outcome measurement resulted in higher risk of bias. Interventions for labor induction, with or without cervical ripening, included pharmacologic (oxytocin, prostaglandins, misoprostol, mifepristone, epidural analgesia), non-pharmacologic (membrane sweep, amniotomy, balloon devices), and combined (pharmacologic and non-pharmacologic). Single studies with small sample sizes and event rates contributed to most comparisons, with no clear differences between groups on rates of VBAC, uterine rupture and uterine dehiscence. This systematic review evaluated clinical interventions directed at increasing the rate of vaginal delivery among women with a prior CD and found low to very low certainty in the body of evidence for cervical ripening and/or labor induction techniques. There is insufficient high-quality evidence to inform optimal clinical interventions among women attempting a trial of labor after a prior CD.
  • Publisher: England: BioMed Central
  • Language: English
  • Identifier: ISSN: 1471-2393
    EISSN: 1471-2393
    DOI: 10.1186/s12884-019-2689-5
    PMID: 31888540
  • Source: GFMER Free Medical Journals
    PubMed Central
    Springer Nature OA/Free Journals
    ROAD: Directory of Open Access Scholarly Resources
    ProQuest Central
    DOAJ Directory of Open Access Journals
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