From: Adjunct clinical interventions that influence vaginal birth after cesarean rates: systematic review
Study; Design; Country, setting; Funding | Population; Study period | Intervention & comparator (no. of participants) | TOLAC ratea | VBAC ratea | VBAC/TOLAC ratea | Population; Study period | |
---|---|---|---|---|---|---|---|
Cleary-Goldman (2005) Prospective cohort with controls US, tertiary care center Non-industry funded | Women eligible for a TOLAC 12-month period | I: one-on-one VBAC counselling, in 2nd and 3rd trimesters (n = 95) | C: no extra counselling, standard care (n = 221) | I: 44 (46.3%) C: 85 (38.5%) | I: 26 (27.4%) C: 70 (31.7%) | I: 26 (59.1%) C: 70 (82.4%) | |
Eden (2014) RCT US, clinics Non-industry funded | Pregnant women with one prior CS, 18 years or older, pregnant with one fetus, low transverse uterine scar, and providers had given option of TOLAC September 17, 2005-May 4, 2007 | I: Evidence-based, interactive decision aid (n = 66) | C: two evidence-based educational brochures about cesarean delivery and VBAC (n = 65) | NR | I: NR (41.0%) C: NR (37.0%), p = 0.724 | NR | |
Fraser (1997) RCT Canada, hospitals Non-industry funded | Women with single previous low transverse CS, gestational age < 28 weeks. April 1992–November 1994 | I: Verbal prenatal education program – pamphlet + 2 individualized contacts (n = 641) | C: Document prenatal education program – written information (n = 634) | I: 465 (72.5%) C: 440 (69.4%); RR 1.1 (95% CI 1.0–1.1) | I: 339 (52.9%) C: 310 (48.9%); RR 1.1 (95% CI 1.0–1.2) | I: 339 (72.9%) C: 310 (70.5%) | |
Gardner (2014) Non-concurrent cohort Australia, metropolitan teaching hospital Funding NR | Women with a single prior CS, presenting in their next pregnancy 2006 (before) & May 2009–October 2010 | Grp 1 (2006): routine care, counselling for mode of birth on ad-hoc basis (n = NR) | Grp 2 (2009–2010): two combined management strategies – Risk Associated Pregnancy consultant & NBAC clinic (n = 396) | Grp 1: NR Grp 2: 164 (41.4%) | VBAC rate for NBAC Grp 1: NR (17.2%) Grp 2: 107 (27.0%), p < 0.001 | Grp 1: NR Grp 2: 107 (65.2%) | |
Montgomery (2007) RCT UK, maternity units Non-industry funded | Pregnant women with one previous lower segment CS, delivery expected at ≥37 weeks; most recent delivery is cesarean. May 2004–August 2006 | I 1: decision analysis aid (n = 235) | I 2: information program (n = 241) | C: usual care (n = 239) | NR | I 1: 88 (37.4%) I 2: 70 (29.2%) C: 72 (30.3%) I 1 vs. C: aOR 1.42 (95% CI 0.94–2.14), p = 0.22 I 2 vs. C: aOR 0.93 (95% CI 0.61–1.41), p > 0.9 I1 vs. I2: aOR 1.53 (95% CI 1.01–2.30), p = 0.11 | NR |
Wong (2014) Prospective cohort UK, district general hospital Funding NR | Women with one previous lower segment CS, no contraindications for VBAC 12-month period commencing January 1, 2012 | I: one-stop obstetrician-led cesarean education and antenatal sessions (OCEANS) (n = 188) | C: did not attend OCEANS (n = 78) | I: 108 (57.4%) C: 33 (42.3%), p = 0.02 | I: 59 (31.4%) C: 20 (25.6%) | I: 59 (54.6%) C: 20 (60.6%) p = 0.69†|