Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

  • Review
  • Intervention

Authors

  • Jodie M Dodd,

    Corresponding author
    1. The University of Adelaide, School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
    • Jodie M Dodd, School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia. jodie.dodd@adelaide.edu.au.

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  • Caroline A Crowther,

    1. The University of Adelaide, ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
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  • Erasmo Huertas,

    1. Materno Perinatal Institute of Lima-Peru, Adolescence Unit, Lima 01, Peru
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  • Jeanne-Marie Guise,

    1. Oregon Health and Science University, Departments of Obstetrics and Gynecology, and Medical Informatics and Clinical Epidemiology, Portland, Oregon, USA
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  • Dell Horey

    1. La Trobe University, Research Education & Development Unit, Bundoora, VIC, Australia
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Abstract

Background

When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. While there are risks and benefits for both planned elective repeat caesarean birth and planned vaginal birth after caesarean, current sources of information are limited to non-randomised cohort studies. Studies designed in this way have significant potential for bias and consequently conclusions based on these results are limited in their reliability and should be interpreted with caution.

Objectives

To assess, using the best available evidence, the benefits and harms of a policy of planned elective repeat caesarean section with a policy of planned vaginal birth after caesarean section for women with a previous caesarean birth.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (24 June 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), and PubMed (1966 to 24 June 2004). We upated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register (11 June 2012) and added the results to the awaiting classification section of the review.

Selection criteria

Randomised controlled trials with reported data that compared outcomes in mothers and babies who planned a repeat elective caesarean section with outcomes in women who planned a vaginal birth, where a previous birth had been by caesarean.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data.

Main results

There were no randomised controlled trials identified.

Authors' conclusions

Planned elective repeat caesarean section and planned vaginal birth after caesarean section for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is drawn from non-randomised studies, associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned vaginal birth for women with a previous caesarean birth.

[Note: the five reports in the awaiting classification section may alter the conclusions of the review once assessed.]

Plain language summary

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. Both forms of care have benefits and risks associated with them. There were no trials to help women, their partners and their caregivers make this choice.