Better Evidence Needed to Guide Delivery Decisions After a Previous Cesarean, Cochrane Group Finds

Randomized controlled trials are need to evaluate the benefits and risks associated with planned elective repeat cesarean section or planned vaginal birth after a woman has had a previous cesarean birth, according to a Cochrane review published online last month.

The Cochrane Pregnancy and Childbirth Group reviewers, led by Jodie M. Dodd, PhD, of the University of Adelaide in Australia, found only two small, randomized trials that evaluated the options. But the trials, they concluded, did not offer much insight.

Both trials had limited data, and only one trial included clinical outcomes data for mother and infant. That trial involved just 22 women, and the risk ratio of death or serious morbidity for both infants and mothers was not estimable. The study showed no statistically significant differences between planned cesarean birth and planned vaginal birth after a previous cesarean delivery.

The Cochrane reviewers noted that both options have benefits and risks associated with them and that additional study is needed to help women, their partners, and their caregivers make an informed decision.

Currently, decisions related to delivery method are being made based on evidence from nonrandomized cohort studies containing potential bias, the reviewers advised. “Any results and conclusions must therefore be interpreted with caution,” they counseled in their summary.

Pertinent Points:
- There is a lack of evidence evaluating the benefits and risks associated with planned elective repeat cesarean or planned vaginal birth for women who have had a previous cesarean birth.
- The reviewers called for more randomized controlled trials into differences between cesarean or vaginal birth after a previous cesarean birth.

References:

Reference

Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth.

Cochrane Database System Rev.

2013;12:CD004224. DOI:10.1002/14651858.CD004224.pub3.