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Trial of labour after caesarean section in sub-Saharan Africa: ameta-analysis

  1. Michel Boulvain Research Fellow 1,3,*,
  2. William D. Fraser Associate Professor 1,
  3. Gisèle Brisson-Carroll Professor 2,
  4. Gilles Faron Research Fellow 1,
  5. Elizabeth Wallast Professor 3

Article first published online: 19 AUG 2005

DOI: 10.1111/j.1471-0528.1997.tb11008.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 104, Issue 12, pages 1385–1390, December 1997

Additional Information

How to Cite

Boulvain, M., Fraser, W. D., Brisson-Carroll, G., Faron, G. and Wallast, E. (1997), Trial of labour after caesarean section in sub-Saharan Africa: ameta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 104: 1385–1390. doi: 10.1111/j.1471-0528.1997.tb11008.x

Author Information

  1. 1

    Centre Hospitaller Universitaire de Québec, Qué Abec, Canada

  2. 2

    School of Nursing, Ottawa University, Ottawa, Canada

  3. 3

    Ecolede Santé Publique, Université Alibrede Bruxelles, Brussels, Belgium

*Correspondence: Dr M. Boulvain, Unité de Développement en Obstétrique, Hôpitaux Universitaires de Genkve, Boulevard de la Cluse 30, Geneva 14, CH-1211 Switzerland.

Publication History

  1. Issue published online: 19 AUG 2005
  2. Article first published online: 19 AUG 2005
  3. Received 23 January 1997 Returned for revision 16 April 1997 Accepted 18 June 1997

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Objective To evaluate the safety and effectiveness of apolicy of trial of labour for women with a previous caes are an section, delivering in hospitals in sub-Saharan Africa.

Design Ameta-analysis of 17 published reports. Setting Hospitals located in sub-Saharan Africa.

Main outcome measures The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical condition swere computed using an approach equivalent to a random effects model.

Results The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI63–75%). Maternal mortality among all women with aprevious caesarean section was 1.9/1000 (95%CI0–4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95%CI1.0–3.2). Criteria used to select women foratrial of labour appeared to have a limited impact on the probability of vaginal delivery.

Conclusions In hospitals in sub-Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.

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