Comparison between TOLAC and ERCS in pregnant women with prior cesarean delivery

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Created On: 18/08/2023

A systematic review and meta-analysis was conducted to assess the safety of attempting a vaginal delivery after a previous cesarean section (known as trial of labor after cesarean section [TOLAC]) compared to opting for an elective repeat cesarean section (ERCS).

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Key take away

Trial of labor after cesarean section in pregnant women carries a higher risk of perinatal death, neonatal asphyxia, and uterine rupture compared to elective repeat cesarean section.

Background

Method

Databases such as Cochrane Library, PubMed, and EMBASE were screened to identify studies that reported the safety outcomes of TOLAC and ERCS in pregnant women with a history of prior cesarean delivery. The statistical analysis was carried out utilizing Stata 15.0 and RevMan 5.3 software. As the effective measures, 95% confidence intervals (CIs) and odds ratios (ORs) were utilized.

Result

This meta-analysis incorporated 13 studies, encompassing a large sample size of 676,532 cases. The findings indicated that the TOLAC group had greater rates of perinatal death (OR = 1.71, I2 = 0%), neonatal asphyxia (OR = 2.32, I2 = 0%), and uterine rupture (OR = 3.35, I2 = 81%) contrasted to the ERCS group. However, there were no substantial differences between the two groups in terms of rates of puerperal infection (OR = 1.11, I2 = 95%), blood transfusion (OR = 1.24, I2 = 95%), and peripartum hysterectomy (OR = 0.70, I2 = 62%).

Conclusion

Choosing TOLAC is linked to a greater likelihood of experiencing perinatal death, neonatal asphyxia, and uterine rupture when compared to opting for ERCS. However, it is essential to acknowledge that the overall risks of these complications were relatively low in both TOLAC and ERCS groups. This information holds significance for healthcare professionals and women who are making decisions regarding the type of delivery.