Vaginal birth after Caesarean versus elective repeat Caesarean for women with a single prior Caesarean birth: A systematic review of the literature

Aims: To assess the benefits and harms of planned elective repeat Caesarean section with planned vaginal birth after Caesarean section (VBAC). Methods: The Cochrane controlled trials register and MEDLINE (1966-current) were searched using the following terms: vaginal birth after C(a)esare(i)an,- trial of labo(u)r,- elective C(a)csare(i)an; C(a)esare(i)an section, repeat; randomis(z)ed controlled trial; randomis(z)ed trial; clinical trial; and prospective cohort study, to identify all published randomised controlled trials and prospective, cohort studies. Primary outcomes related to success of trial of labour, need for Caesarean section, maternal and neonatal mortality, and morbidity. Results: There were no randomised controlled trials identified that compared planned elective repeat Caesarean birth with planned vaginal birth. Two prospective cohort studies were identified where all 449 women compared had a single prior Caesarean section in their immediately preceding pregnancy and were suitable for an attempted VBAC in their next pregnancy. For all outcomes, data were available from a single study only. Reported outcome data were available for maternal deaths (0/137 women), in utero fetal deaths (2/312 fetuses), neonatal deaths (0/137 infants), uterine sear dehiscence (2/137 women), uterine scar rupture (1/312 women), and infant Apgar score of less than seven at 5 min of age (9/312 infants). There were no statistically significant differences between planned elective repeat Caesarean section and planned VBAC. Conclusions: There is a paucity of quality information available to assist women and their caregivers regarding optimal mode of birth for women with a single prior Caesarean section in their next pregnancy.