Abstract:
Background: Intrapartum decision-making for women with a
previous caesarean section (CS) is complex due to competing risks of
trial of labour after cesarean (TOLAC) and elective repeat CS (ERCS).
Objective: Determine rates of TOLAC and vaginal birth after
cesarean (VBAC) in sub-Saharan Africa (SSA) and estimate rates of
adverse events associated with TOLAC versus ERCS.
Search Strategy: We searched PubMed, MEDLINE, CAB, EMBASE, and
African-specific databases.
Selection Criteria: We included studies with at least one
previous CS conducted in SSA.
Data Collection and Analysis: W e extracted data on study
design, planned and actual delivery mode, and maternal and perinatal
outcomes. We calculated median TOLAC and VBAC rates pooled mean uterine
rupture rate and compared uterine rupture rates and mortality between
TOLAC and ERCS.
Main Results: From 51 included studies, the median TOLAC and
VBAC rates, weighted for sample size, were 75% (IQR: 40-100%) and 34%
(IQR: 24-44%) , respectively; and the weighted mean uterine rupture
rate was 1.3% (SD: 1.6%). The uterine rupture rate [1.2% vs 0.2%,
OR 1.54 (95% CI 0.63-3.75)] and maternal mortality [0.3% vs
<0.1%, OR 0.77 (95% CI 0.30-1.98)] did not differ
significantly between TOLAC and ERCS groups, respectively, however
perinatal mortality was higher for the TOLAC group (5% vs 1%, OR 3.3 ;
95% CI 1.5-6.9)
Conclusions: We found high rates of TOLAC and moderate rates of
VBAC across SSA, with a perinatal but no maternal benefit to ERCS
compared to TOLAC. Further research is needed to understand delivery
outcomes in this population of women.