Regional and temporal variation
Most studies were conducted in WestAfrica, with the majority, 31% (n=26), carried out in Nigeria alone (Table 3). There was relatively little representation from Central Africa (n=4). Median TOLAC rates were highest in Central Africa at 91.6%, compared to 49% in Eastern Africa, which had the lowest rate. Adverse outcomes also varied with higher reported rates of perinatal mortality in the one study from Central Africa (115), compared to the sub-regional average for Western Africa (2.2%), and higher reported rates of uterine rupture/dehiscence (8.8% vs 1.3%) respectively. In studies conducted before and after 1996, median TOLAC rates were 90% and 76% (p=0.41), and median VBAC rates were 50% and 36%, respectively (p=0.14), respectively (Figure 3).