The safety of trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section (ERCS) : a systematic review and meta-analysis
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians - 36(2023), 1 vom: 07. Dez., Seite 2214831 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Qiu, Lili [VerfasserIn] |
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| Links: |
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| Themen: |
Elective repeat cesarean section (ERCS;) |
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| Anmerkungen: |
Date Completed 24.05.2023 Date Revised 24.05.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1080/14767058.2023.2214831 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357199073 |
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| 245 | 1 | 4 | |a The safety of trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section (ERCS) |b a systematic review and meta-analysis |
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| 500 | |a Date Revised 24.05.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Safety | |
| 650 | 4 | |a elective repeat cesarean section (ERCS;) | |
| 650 | 4 | |a meta-analysis | |
| 650 | 4 | |a trial of labor after cesarean section (TOLAC) | |
| 650 | 4 | |a uterine rupture | |
| 700 | 1 | |a Zhu, Jingjing |e verfasserin |4 aut | |
| 700 | 1 | |a Lu, Xianyan |e verfasserin |4 aut | |
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