Amhara Public Health Institute, Bahir Dar, Ethiopia.
Janamora Primary Hospital, Amhara Reginal State Health Bureau, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2023 Jan 26;23(1):65. doi: 10.1186/s12884-023-05396-w.
The rates of successful vaginal birth after previous cesarean section (VBAC) have been increasing with minimal complication. Successful vaginal birth after cesarean section improves maternal and fetal outcomes by shortening the length of hospital stay, avoiding abdominal surgery, decreasing the risk of infections and hemorrhage, and decreasing injury of the bladder and bowel. Despite a few single studies stating different predictors of successful VBAC, there is a lack of nationwide data to show the determinants of successful VBAC. Thus, this meta-analysis aimed to determine the predictors of successful VBAC in Ethiopia.
A systematic literature search was performed from PubMed, Web of Sciences, EMBASE, CINAHL, and Google scholar until July 25, 2022. The quality of included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist. The analysis was executed using Stata 14 statistical software. Heterogeneity was evaluated statistically using Cochran's Q-statistic and quantified by the I value. A random-effects model was used to estimate the determinants of successful vaginal birth after a cesarean section if substantial heterogeneity was detected across included studies; otherwise, a fixed-effects model was used.
Women living in rural residence (AOR: 2.14; 95% CI: 1.01, 4.52), history of previous spontaneous vaginal delivery (AOR: 2.92; 95% CI: 2.02, 4.23), previous successful vaginal birth after previous cesarean section (AOR: 5.29; 95% CI: 2.20, 12.69), history of stillbirth (AOR: 1.57; 95% CI: 1.20, 2.04), cervical dilation of ≥ 4 cm at admission (AOR: 2.14; 95% CI: 1.27, 3.61), spontaneous ruptured membranes at admission (AOR: 1.32; 95% CI: 1.17, 1.48) were independent determinants of successful vaginal birth after previous cesarean section.
The results of this meta-analysis showed that successful VBAC was influenced by past and present obstetric conditions and other predictors. Thus, it is recommended that obstetric care providers should emphasize those factors that lead to successful vaginal birth during counseling and optimal selection of women for the trial of labour after cesarean section.
SYSTEMATIC REVIEW AND META-ANALYSIS REGISTRATION: PROSPERO CRD42022329567.
经剖宫产（VBAC）后的阴道分娩成功率有所提高，且并发症极少。VBAC 可缩短产妇住院时间，避免腹部手术，降低感染和出血风险，并减少膀胱和肠道损伤，从而改善母婴结局。尽管有一些单因素研究提出了 VBAC 成功的不同预测因素，但缺乏全国性数据来显示 VBAC 成功的决定因素。因此，本荟萃分析旨在确定埃塞俄比亚 VBAC 成功的预测因素。
从 PubMed、Web of Sciences、EMBASE、CINAHL 和 Google Scholar 进行了系统文献检索，检索截至 2022 年 7 月 25 日。使用 Joanna Briggs 研究所（JBI）的批判性评价检查表评估纳入研究的质量。使用 Stata 14 统计软件进行分析。如果纳入研究存在显著异质性，则使用 Cochran's Q 统计量进行统计学评估，并通过 I 值进行量化。如果存在显著异质性，则使用随机效应模型估计剖宫产术后阴道分娩成功的决定因素；否则，使用固定效应模型。
居住在农村（AOR：2.14；95%CI：1.01，4.52）、既往自发性阴道分娩史（AOR：2.92；95%CI：2.02，4.23）、既往剖宫产术后阴道分娩成功史（AOR：5.29；95%CI：2.20，12.69）、死胎史（AOR：1.57；95%CI：1.20，2.04）、入院时宫颈扩张≥4cm（AOR：2.14；95%CI：1.27，3.61）、入院时胎膜自然破裂（AOR：1.32；95%CI：1.17，1.48）是剖宫产术后阴道分娩成功的独立预测因素。
本荟萃分析结果表明，VBAC 的成功受到过去和现在的产科情况和其他预测因素的影响。因此，建议产科护理提供者在咨询和剖宫产术后试产的妇女最佳选择中应强调导致阴道分娩成功的因素。
PROSPERO CRD42022329567。
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