North Middlesex University Hospital NHS Trust, Sterling Way, London, N181QX, United Kingdom.
Department of Women and Children's Health, King's College London, 10th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge Road, London SE17EH, United Kingdom.
Midwifery. 2024 Dec;139:104168. doi: 10.1016/j.midw.2024.104168. Epub 2024 Aug 31.
There is a limited knowledge base available to midwives, obstetricians and women planning vaginal birth after caesarean (VBAC), impeding their ability to make informed choices regarding planned place of birth.
A VBAC is associated with fewer complications for both mother and baby, but little is known on the safety and success of planning a VBAC in midwifery led settings such as birth centres and home birth, compared to obstetric led settings.
To synthesise the findings of published studies regarding maternal and neonatal outcomes with planned VBAC in midwifery setting compared to obstetric units.
PubMed, EMBASE, CINAHL complete, Maternity and Infant Care, PsycINFO, and Science Citation Index databases were systematically searched on 16/08/2022 for all quantitative research on the outcomes for women planning VBAC in midwifery led settings compared to obstetric led settings in high income countries. Included studies were quality assessed using the CASP Checklist. Binary outcomes are incorporated into pairwise meta-analyses, effect sizes reported as risk ratios with 95 % confidence intervals. A τ² estimate of between-study variance was performed for each binary outcome analysis. Other, more heterogeneous outcomes are narratively reported.
Two high-quality studies, out of 420 articles, were included. VBAC planned in a midwifery-led setting was associated with a statistically significant increase in unassisted vaginal birth (RR=1.42 95 % CI 1.37 to 1.48) and decrease in emergency caesarean section (RR= 0.46 95 % CI 0.39 to 0.56) and instrumental birth (RR= 0.33 95 % CI 0.23 to 0.47) compared with planned VBAC in an obstetric setting. There were no significant differences in uterine rupture (RR= 1.03 95 % CI 0.52 to 2.07), admission to special care nursery (RR= 0.71 95 % CI 0.47 to 1.23) or Apgar score of 7 or less at 5 min (RR= 1.16 95 % CI 0.66 to 2.03).
Planning VBAC in midwifery led settings is associated with increased vaginal birth and a reduction in interventions such as instrumental birth and caesarean section. Adverse perinatal outcomes are rare, and further research is required to draw conclusions on these risks.
助产士、产科医生和计划阴道分娩（VBAC）的女性可用的知识库有限，这阻碍了他们就计划分娩地点做出知情选择的能力。
VBAC 与母婴并发症减少有关，但与产科主导的环境相比，对于在生育中心和家庭分娩等助产士主导的环境中计划 VBAC 的安全性和成功率知之甚少。
综合发表的研究结果，以了解与计划在助产士主导的环境中进行 VBAC 相比，在产科主导的环境中进行 VBAC 的母婴结局。
2022 年 8 月 16 日，系统检索了 PubMed、EMBASE、CINAHL 完整、产妇和婴儿护理、PsycINFO 和科学引文索引数据库，以获取所有关于高收入国家中在助产士主导的环境中计划 VBAC 的女性与在产科主导的环境中进行 VBAC 的女性的结局的定量研究。使用 CASP 清单对纳入的研究进行质量评估。二项结局被纳入成对的荟萃分析，效应大小报告为风险比，置信区间为 95%。对每项二项结局分析进行了研究间方差的 τ²估计。其他更异质的结局则进行叙述性报告。
在 420 篇文章中，有两项高质量的研究被纳入。与在产科主导的环境中计划 VBAC 相比，在助产士主导的环境中计划 VBAC 与未经辅助的阴道分娩（RR=1.42，95%CI 1.37 至 1.48）增加和紧急剖宫产（RR=0.46，95%CI 0.39 至 0.56）和器械分娩（RR=0.33，95%CI 0.23 至 0.47）的发生率降低有关。子宫破裂（RR=1.03，95%CI 0.52 至 2.07）、特殊护理新生儿病房入院（RR=0.71，95%CI 0.47 至 1.23）或 5 分钟时 Apgar 评分 7 分或更低（RR=1.16，95%CI 0.66 至 2.03）的发生率无显著差异。
在助产士主导的环境中计划 VBAC 与阴道分娩增加以及器械分娩和剖宫产等干预措施减少有关。围产期不良结局罕见，需要进一步研究才能得出这些风险的结论。
