Trial of labor after three previous cesarean sections: Is it really something crazy? Result of a systematic review and meta-analysis

Abstract Background Trial of labor after a previous cesarean delivery (TOLAC) has helped to reduce the rate of cesarean section (CS). But the increased rate of adverse outcomes limites the spread of TOLAC. The most serious one is the risk of symptomatic uterine rupture, which is possibly associated with oxytocin. This meta-analysis was to evaluate the risk association between oxytocin use and uterine rupture in TOLAC. Methods Multiple electronic databases (PubMed, Embase, Web of Science, and Google Scholar) were searched for case-control or cross-sectional studies about TOLAC, oxytocin and uterine rupture, which were published between January 1986 and October 2019. The bias-corrected Hedge's g was calculated as the effect size using the random-effects model. The risk of bias was evaluated by the Newcastle-Ottawa Scale (NOS). Quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty ratings system. Results There were 14 studies meeting inclusion criteria including 48457 women undergoing TOLAC. The pooled rate of VBAC and rate of uterine rupture in spontaneous labor were 74.3% and 0.7%. And the pooled rate of VBAC and rate of uterine rupture in induction labor were 60.7% and 2.2%. The women with spontaneous labor had significantly higher rate of VBAC (p=0.0032) and lower rate of uterine rupture (p=0.0003) than that with induction labor. The pooled rates of uterine rupture in women using oxytocin and women not using oxytocin in TOLAC were 1.4% and 0.5%. There was significant difference between these two groups (p=0.0002). Conclusions In TOLAC, women with induction labor had higher risk of uterine rupture than that with spontaneous labor. Oxytocin use may increase the risk. So simplified and standardized intrapartum management, precise procotol and cautiously monitoring of oxytocin in TOLAC are necessary.

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Membrane sweeping in patients planning a trial of labor after cesarean: a systematic review and meta-analysis of randomized controlled trials

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2019.1569612 ◽

2019 ◽

Vol 33 (18) ◽

pp. 3103-3110

Author(s):

Odessa Hamidi ◽

Johanna Quist-Nelson ◽

Serena Xodo ◽

Vincenzo Berghella

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Trial Of Labor ◽

Randomized Controlled

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Trial of Labor and Vaginal Birth after Three Previous Cesarean Sections: Report of Two Special Cases

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-1642-1113 ◽

2022 ◽

Author(s):

Arrigo Fruscalzo ◽

Marwa Elgendi ◽

Marcus Gantert

Keyword(s):

Vaginal Birth ◽

Cesarean Sections ◽

Natural Childbirth ◽

Case Presentation ◽

Trial Of Labor ◽

Detailed Explanation ◽

Special Cases ◽

Potential Risks ◽

First Time ◽

Previous Cesarean

Abstract Background Natural childbirth could represent a deeply rooted need for many women, even in exceptional situations such as after 3 previous caesarean sections. Case presentation The first patient, a 28-year-old 6th gravida and 3rd para, first presented in the 40+3 week of pregnancy desiring a vaginal birth, after all the other hospitals in the area had refused her request. A detailed explanation of potential risks was given and, when 2 days later contractions started, she gave birth to a newborn of 4450 g spontaneously, without complications. A month later, a second woman, 42 years old, 5th gravida, 3rd para, read about the above-mentioned case on social media and decided to attempt a natural delivery after 3 caesarean sections at our hospital as well. She presented herself for the first time in the 41+1 week of pregnancy in our delivery room with an onset of labor after rupture of the membranes and gave birth on the same day, spontaneously without complications, to a 4150 g heavy healthy newborn. Conclusions The wish to attempt a spontaneous birth after 3 previous caesarean sections can be deeply anchored and should be professionally approached by obstetricians, even if counseling and management can be challenging.

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Effects of Psycho-education Interventions on Perceived Childbirth Fear and Anxiety by Pregnant Women: A Systematic Review and Meta-analysis

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2021.44 ◽

2020 ◽

Vol 9 (4) ◽

pp. 230-237

Author(s):

Masomeh Adeli Gargari ◽

Khalil Esmailpour ◽

Mojgan Mirghafourvand ◽

Roghaiyeh Nourizadeh ◽

Esmat Mehrabi

Keyword(s):

Systematic Review ◽

Web Of Science ◽

Meta Analysis ◽

Control Group ◽

Cesarean Sections ◽

Natural Childbirth ◽

Extensive Search ◽

Education Interventions ◽

Fear And Anxiety ◽

Psychoeducational Interventions

Objectives: Phobia of natural childbirth is one of the most important and influencing factors leading women to request cesarean sections. The present study aimed to prepare a systematic review and meta-analysis to investigate the type of interventions related to fear of childbirth (FOC). Materials and Methods: The data collection was based on an extensive search of articles related to clinical trials (1990-2019) posted on Google Scholar, Cochran, SID, Magiran, Web of Science, Scopus, and PubMed electronic databases. In general, 109 abstracts were selected after eliminating similar publications. As a result of the qualitative evaluations of these articles, 11 studies were kept for investigation. Results: The studies were categorized into three groups including prenatal education with childbirth counseling, yoga courses, and psychoeducational-based interventions. Based on the meta-analysis, psychoeducational interventions have a significant effect on childbirth fears and anxiety in comparison with the control group (mean difference: 0.85, 95% CI: -1.20–0.45, P < 0.0001, I2 = 82%). Conclusions: Psychologically-based interventions, can creatively play an essential role in reducing the FOC during pregnancy and even childbirth. It can also create a pleasant and traumatic-free experience which is essential for encouraging women to have a natural childbirth.

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