Trial of labor after cesarean delivery in twin gestations: systematic review and meta-analysis
| Autor: | Bruria Hirsh Raccah, Ilan Matok, Razan Masarwy, Yossef Ezra, Doron Kabiri, Natali Schachter-Safrai, Reem Masarwa |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Hysterectomy Infant Newborn Diseases law.invention Uterine Rupture Randomized controlled trial Pregnancy law Infant Mortality Odds Ratio medicine Elective Cesarean Delivery Humans Blood Transfusion reproductive and urinary physiology Cesarean Section Obstetrics Vaginal delivery business.industry Infant Newborn Pregnancy Outcome Infant Obstetrics and Gynecology Odds ratio medicine.disease Vaginal Birth after Cesarean Trial of Labor female genital diseases and pregnancy complications Uterine rupture Maternal Mortality Pregnancy Twin Gestation Female Uterine Hemorrhage business Cohort study |
| Zdroj: | American Journal of Obstetrics and Gynecology. 220:336-347 |
| ISSN: | 0002-9378 |
| DOI: | 10.1016/j.ajog.2018.11.125 |
| Popis: | Background Trial of labor after cesarean is offered as a routine option for singleton gestations with previous cesarean delivery. However, adequate data are not available to determine whether the approach is equally valid in women with twin gestation. Objective This systematic review and meta-analysis aimed to assess maternal morbidities associated with trial of labor after cesarean delivery in twin gestations. Study Design Electronic databases were searched for cohort studies and randomized controlled trials evaluating the association between trial of labor after cesarean delivery in twin gestations and pregnancy outcomes. Maternal mortality and severe morbidities, such as uterine rupture and hysterectomy, were compared between women who had trial of labor and women who had a planned repeat cesarean delivery. Pooled odds ratios were calculated using a random-effects model. Additional analyses were performed to compare trial of labor after cesarean outcomes in singleton and twin gestations. Results Eleven cohort studies including a total of 8209 twin gestations with previous cesarean delivery were included in the present study. Of these gestations, 2484 were intended for planned vaginal birth and 5725 were intended for planned repeat cesarean delivery. The rate of uterine rupture in twin gestations was higher in the trial of labor after cesarean group than the elective cesarean group (odds ratio, 10.09, 95% confidence interval, 4.30–23.69, I2 = 68%). However, no statistically significant difference was found in the rate of uterine rupture between twin and single gestations attempting trial of labor after cesarean delivery (odds ratio, 1.34, 95% confidence interval, 0.54–3.31, I2 = 0%). Women who attempted a trial of labor after cesarean delivery with twins did not have an increased risk of uterine scar dehiscence, hemorrhage, blood transfusion, or neonatal morbidity and mortality compared with elective repeat cesarean delivery. Patients with twins had similar rates of successful vaginal delivery as patients with singletons (odds ratio, 0.85, 95% confidence interval, 0.61–1.18, I2 = 36%). Conclusion This meta-analysis demonstrates that, although trial of labor with twins after previous cesarean delivery is associated with higher rates of uterine rupture compared with elective cesarean delivery, pregnancy outcomes and success rates are similar to a trial of labor after previous cesarean delivery in singleton gestations. Planned vaginal birth for women with twin gestation and previous cesarean delivery may be a safe alternative to a planned repeat cesarean. |
| Databáze: | OpenAIRE |
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