The safety of trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section (ERCS): a systematic review and meta-analysis.
J Matern Fetal Neonatal Med
; 36(1): 2214831, 2023 Dec.
Article
en En
| MEDLINE
| ID: mdl-37217450
ABSTRACT
OBJECTIVE:
Women's choice of birth following a cesarean delivery either includes a trial of elective repeat cesarean section (ERCS) or a trial of labor after cesarean (TOLAC). No comprehensive overview or systematic summary is currently available.METHODS:
EMBASE, PubMed, and the Cochrane Library databases were searched from inception to 1 February 2020. Studies reporting the safety of TOLAC and ERCS in pregnant women with prior cesarean delivery were included. Statistical analysis was performed using RevMan 5.3 and Stata 15.0. Odds ratios (ORs) and 95% confidence intervals (CIs) were adopted as the effective measures.RESULTS:
A total of 13 studies covering 676,532 cases were included in this meta-analysis. The results demonstrated that the rates of uterine rupture (OR = 3.35, 95%CI [1.57, 7.15], I2 = 81%), neonatal asphyxia (OR = 2.32, 95%CI [1.76, 3.08], I2 = 0%) and perinatal death (OR = 1.71, 95%CI [1.29, 2.25], I2 = 0%) were higher in the TOLAC group compared with the ERCS group. The rates of peripartum hysterectomy (OR = 0.70, 95%CI [0.44, 1.11], I2 = 62%), blood transfusion (OR = 1.24, 95%CI [0.72, 2.12], I2 = 95%), and puerperal infection (OR = 1.11, 95%CI [0.77, 1.60], I2 = 95%) showed no significant differences between the two groups.CONCLUSION:
TOLAC is associated with a higher risk of uterine rupture, neonatal asphyxia, and perinatal death compared with ERCS. Nevertheless, it should be noted that the risks of all complications were small in both groups. This information is important for healthcare providers and women choosing the delivery type.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Rotura Uterina
/
Parto Vaginal Después de Cesárea
/
Muerte Perinatal
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
/
Systematic_reviews
Límite:
Female
/
Humans
/
Newborn
/
Pregnancy
Idioma:
En
Revista:
J Matern Fetal Neonatal Med
Asunto de la revista:
OBSTETRICIA
/
PERINATOLOGIA
Año:
2023
Tipo del documento:
Article
País de afiliación:
China