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. Design A meta-analysis of 17 published reports.:, Setting Hospitals located in sub-Saharan Africa. Main outcome measures 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.