Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis
Abstract Background To systematically review the literature on clinical interventions that influence vaginal birth after cesarean (VBAC) rates. Methods We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by search...
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-019-2689-5 |
| _version_ | 1818383566484013056 |
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| author | Aireen Wingert Lisa Hartling Meghan Sebastianski Cydney Johnson Robin Featherstone Ben Vandermeer R. Douglas Wilson |
| author_facet | Aireen Wingert Lisa Hartling Meghan Sebastianski Cydney Johnson Robin Featherstone Ben Vandermeer R. Douglas Wilson |
| author_sort | Aireen Wingert |
| collection | DOAJ |
| description | Abstract Background To systematically review the literature on clinical interventions that influence vaginal birth after cesarean (VBAC) rates. Methods We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by searching for clinical trial records, conference proceedings and dissertations. Limits were applied for language (English and French) and year of publication (1985 to present). Two reviewers independently screened comparative studies (randomized or non-randomized controlled trials, and observational designs) according to a priori eligibility criteria: women with prior cesarean sections; any clinical intervention or exposure intended to increase the VBAC rate; any comparator; and, outcomes reporting VBAC, uterine rupture and uterine dehiscence rates. One reviewer extracted data and a second reviewer verified for accuracy. Meta-analysis was conducted using Mantel-Haenszel (random effects model) relative risks (VBAC rate) and risk differences (uterine rupture and dehiscence). Two reviewers independently conducted methodological quality assessments using the Mixed Methods Appraisal Tool (MMAT). Results Twenty-nine studies (six trials and 23 cohorts) examined different clinical interventions affecting rates of vaginal deliveries among women with a prior cesarean delivery (CD). Methodological quality was good overall for the trials; however, concerns among the cohort studies regarding selection bias, comparability of groups and outcome measurement resulted in higher risk of bias. Interventions for labor induction, with or without cervical ripening, included pharmacologic (oxytocin, prostaglandins, misoprostol, mifepristone, epidural analgesia), non-pharmacologic (membrane sweep, amniotomy, balloon devices), and combined (pharmacologic and non-pharmacologic). Single studies with small sample sizes and event rates contributed to most comparisons, with no clear differences between groups on rates of VBAC, uterine rupture and uterine dehiscence. Conclusions This systematic review evaluated clinical interventions directed at increasing the rate of vaginal delivery among women with a prior CD and found low to very low certainty in the body of evidence for cervical ripening and/or labor induction techniques. There is insufficient high-quality evidence to inform optimal clinical interventions among women attempting a trial of labor after a prior CD. |
| first_indexed | 2024-12-14T03:08:24Z |
| format | Article |
| id | doaj.art-0432f2c5eae74bc08de4b64c9080e5f7 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-14T03:08:24Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-0432f2c5eae74bc08de4b64c9080e5f72022-12-21T23:19:20ZengBMCBMC Pregnancy and Childbirth1471-23932019-12-0119111910.1186/s12884-019-2689-5Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-AnalysisAireen Wingert0Lisa Hartling1Meghan Sebastianski2Cydney Johnson3Robin Featherstone4Ben Vandermeer5R. Douglas Wilson6Department of Pediatrics, Alberta Research Centre for Health Evidence, University of AlbertaDepartment of Pediatrics, Alberta Research Centre for Health Evidence, University of AlbertaAlberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of AlbertaDepartment of Pediatrics, Alberta Research Centre for Health Evidence, University of AlbertaDepartment of Pediatrics, Alberta Research Centre for Health Evidence, University of AlbertaDepartment of Pediatrics, Alberta Research Centre for Health Evidence, University of AlbertaDepartment of Obstetrics and Gynecology, Cumming School of Medicine, University of CalgaryAbstract Background To systematically review the literature on clinical interventions that influence vaginal birth after cesarean (VBAC) rates. Methods We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by searching for clinical trial records, conference proceedings and dissertations. Limits were applied for language (English and French) and year of publication (1985 to present). Two reviewers independently screened comparative studies (randomized or non-randomized controlled trials, and observational designs) according to a priori eligibility criteria: women with prior cesarean sections; any clinical intervention or exposure intended to increase the VBAC rate; any comparator; and, outcomes reporting VBAC, uterine rupture and uterine dehiscence rates. One reviewer extracted data and a second reviewer verified for accuracy. Meta-analysis was conducted using Mantel-Haenszel (random effects model) relative risks (VBAC rate) and risk differences (uterine rupture and dehiscence). Two reviewers independently conducted methodological quality assessments using the Mixed Methods Appraisal Tool (MMAT). Results Twenty-nine studies (six trials and 23 cohorts) examined different clinical interventions affecting rates of vaginal deliveries among women with a prior cesarean delivery (CD). Methodological quality was good overall for the trials; however, concerns among the cohort studies regarding selection bias, comparability of groups and outcome measurement resulted in higher risk of bias. Interventions for labor induction, with or without cervical ripening, included pharmacologic (oxytocin, prostaglandins, misoprostol, mifepristone, epidural analgesia), non-pharmacologic (membrane sweep, amniotomy, balloon devices), and combined (pharmacologic and non-pharmacologic). Single studies with small sample sizes and event rates contributed to most comparisons, with no clear differences between groups on rates of VBAC, uterine rupture and uterine dehiscence. Conclusions This systematic review evaluated clinical interventions directed at increasing the rate of vaginal delivery among women with a prior CD and found low to very low certainty in the body of evidence for cervical ripening and/or labor induction techniques. There is insufficient high-quality evidence to inform optimal clinical interventions among women attempting a trial of labor after a prior CD.https://doi.org/10.1186/s12884-019-2689-5Vaginal birth after cesareanTrial of labor after cesareanSystematic reviewMeta-analysis |
| spellingShingle | Aireen Wingert Lisa Hartling Meghan Sebastianski Cydney Johnson Robin Featherstone Ben Vandermeer R. Douglas Wilson Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis BMC Pregnancy and Childbirth Vaginal birth after cesarean Trial of labor after cesarean Systematic review Meta-analysis |
| title | Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis |
| title_full | Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis |
| title_fullStr | Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis |
| title_full_unstemmed | Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis |
| title_short | Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis |
| title_sort | clinical interventions that influence vaginal birth after cesarean delivery rates systematic review meta analysis |
| topic | Vaginal birth after cesarean Trial of labor after cesarean Systematic review Meta-analysis |
| url | https://doi.org/10.1186/s12884-019-2689-5 |
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