Document Type : Review Article
Authors
- Leila Pourali 1
- maryam salehi 2
- reyhaneh rahmani 3
- elmira fardi 4
- sedigheh ayati 5
- hasan Mehrad-Majd 6
- mehrdad gazanchian 7
- elham rahmanipour 8
- mohammad ghorbani 9
- Ali mehri 10
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Socio-Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 General Practitioner, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4 General Dentist, Islamic Azad University of Tehran, Medical Branch.
5 Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
6 Clinical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
7 Student Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
8 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
9 Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
10 Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Background: Vaginal birth after Caesarean (VBAC) is often offered as an option after a single caesarean section (CS).
Objectives: to evaluate the success rate of vaginal birth after two caesarean sections (VBAC-2).
Search strategy: Systematic review and meta-analysis
Selection criteria and Data collection: We searched MEDLINE, EMBASE, PubMed, Scopus, using search terms (cesarean OR cesarean OR caesarean OR caesarian) AND (“Vaginal birth after” OR VBAC) AND (two OR Twice OR second OR multiple Two independent reviewers performed the study selection, and abstracted and tabulated data and pooled estimates were obtained. Meta-analyses were performed using Open-meta and Comprehensive Meta-Analysis.
Main results: Mean success rate of VBAC-2 was 72% (2174 out of 3020 cases) with a range of 24-90%. Mean hysterectomy rate was 0.43% ranging from 0% to 1.7%. Our meta-analysis showed no significant difference between VBAC-2 and CS-3 in the case of hysterectomy, with a pooled odds ratio (OR) of 0.699, but with a wide confidence interval (95% CI was 0.347-1.407). VBAC-2 being associated with 2 fold increased risk of perinatal mortality compared to CS-3.
Conclusion: Vaginal delivery is a suitable option for women with two previous cesarean sections, the outcomes are significantly more favorable for women with history of vaginal birth.
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