- Research article
- Open Access
Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis
BMC Pregnancy and Childbirth volume 19, Article number: 360 (2019)
Evidence for the relationship between maternal and perinatal factors and the success of vaginal birth after cesarean section (VBAC) is conflicting. We aimed to systematically analyze published data on maternal and fetal factors for successful VBAC.
A comprehensive search of Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature, from each database’s inception to March 16, 2018. Observational studies, identifying women with a trial of labor after one previous low-transverse cesarean section were included. Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale.
We included 94 eligible observational studies (239,006 pregnant women with 163,502 VBAC). Factors were associated with successful VBAC with the following odds ratios (OR;95%CI): age (0.92;0.86–0.98), obesity (0.50;0.39–0.64), diabetes (0.50;0.42–0.60), hypertensive disorders complicating pregnancy (HDCP) (0.54;0.44–0.67), Bishop score (3.77;2.17–6.53), labor induction (0.58;0.50–0.67), macrosomia (0.56;0.50–0.64), white race (1.39;1.26–1.54), previous vaginal birth before cesarean section (3.14;2.62–3.77), previous VBAC (4.71;4.33–5.12), the indications for the previous cesarean section (cephalopelvic disproportion (0.54;0.36–0.80), dystocia or failure to progress (0.54;0.41–0.70), failed induction (0.56;0.37–0.85), and fetal malpresentation (1.66;1.38–2.01)). Adjusted ORs were similar.
Diabetes, HDCP, Bishop score, labor induction, macrosomia, age, obesity, previous vaginal birth, and the indications for the previous CS should be considered as the factors affecting the success of VBAC.
Cesarean delivery rates have increased dramatically worldwide. In the United States, cesarean section (CS) rates increased from 5% of all deliveries in 1970 to a high of 31.9% in 2016  .Although efforts were made to reduce the number of CS, it failed to achieve the 15% rate recommended by the World Health Organization (WHO) .
Repeat CS is the most significant factor contributing to overall increased CS rates . The primary indication of repeat CS is a prior CS . The trial of labor after cesarean (TOLAC) is an attempt to reduce CS rates. Several national medical associations have provided practice guidelines for vaginal birth after cesarean section (VBAC) [4, 5], but these differ across countries . Generally speaking, VBAC is relatively safe when compared with repeat CS  .However, TOLAC rates have dropped significantly worldwide in recent years [8, 9].
For women with a prior cesarean delivery, a trial of labor will often represent her last opportunity to experience a normal birth. However, a failed VBAC increases the risk of maternal and perinatal complications more than an elective repeat CS  .A potential solution to the concerns related to VBAC would be a more accurate selection of patients opting for TOLAC . Early communication to discuss women’s prospects for VBAC success and their attitudes towards future births might be valuable. The probability of successful vaginal birth is one of the most crucial factors in the decision-making process during the prenatal counseling of these women.
Two previous meta-analyses were published in 1990 (Rosen et al.) and in 2010 (Eden et al.). Rosen et al. focused on the indicators in the previous cesarean for VBAC success . Eden et al. focused on studies about predictors of VBAC, which were conducted in developed countries . They found that cephalopelvic disproportion (CPD) in the previous cesarean, previous breech, previous vaginal delivery, more than one previous cesarean, Hispanic ethnicity, advanced age, birth weight heavier than 4 kg, and use of either augmentation or induction affected the likelihood of VBAC. However, no previous meta-analysis has focused on the influences of obesity, diabetes, hypertensive disorders complicating pregnancy (HDCP), gestational weeks, and interdelivery interval on the chance of VBAC, which were conflicting.
Therefore, we aimed to perform a systematic review and meta-analysis of all published reports until 2018 of vaginal birth after one previous cesarean and maternal or fetal factors from the historical and current pregnancies, and to quantify the magnitude of each factor and the quality of the supporting data.
The study was conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations (Additional file 22: Text S1). We have reported our findings following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines (Additional file 23: Text S2). We submitted the protocol to Prospero before initiation of the analyses (ID: CRD42018087395).
A search for the following sources was performed from database inception until March 16, 2018: Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature. We used Medical Subject Headings, keywords and word variants for the trial of labor, vaginal birth and cesarean in the search strategy, with the help of an experienced librarian. The search strategy is outlined in the Additional file 24: Appendix 1. Bibliographies of selected review articles were reviewed for additional relevant studies. Only studies about human data published in or translated into English were included. The Countway Library of Medicine at Harvard Medical School assisted with crafting and implementing the literature search,
Exposure was defined as maternal or fetal factors for VBAC. Factors related to previous pregnancies included: previous vaginal birth (VB) before CS, previous VBAC, and indications for the previous CS. Factors from the current pregnancy included: age (year), body mass index (BMI, kg/m2), obesity (BMI ≥ 30 kg/m2), smoke, race (White, Asian, Black, Latina), diabetes (pre-existing, gestational diabetes mellitus), hypertensive disorders complicating pregnancy (HDCP), interdelivery interval (between the last two pregnancies), gestational weeks, Bishop score at admission before delivery, labor induction, epidural anesthesia during labor, and macrosomia (birth weight ≥ 4 kg).
TOLAC was defined as an attempt at vaginal delivery after a previous cesarean section. A successful VBAC is defined as spontaneous or instrumental (assisted by vacuum or forceps) delivery to a woman undergoing TOLAC. A failed VBAC is defined as failure to achieve a VBAC and the delivery ending by emergency cesarean section. In the study, all of the pregnant women had experienced TOLAC, and were grouped as successful VBAC or failed VBAC.
The target population of the study included women of child-bearing ages, with a single gestation and, one previous cesarean delivery, and that were candidates for attempted vaginal birth.
The following criteria were required for eligibility: 1) mean and SD of the continuous factors and N in women with successful VBAC and failed VBAC, or 2) unadjusted and/ or adjusted odds ratio (OR) and 95% confidence interval (CI) for the binary factors in women with successful VBAC and failed VBAC, or 3) raw N for the 2*2 tables to calculate the OR and 95% CI for the binary factors in women with successful VBAC and failed VBAC.
We excluded women with more than one previous cesarean delivery; known previous classical uterine incision or T-incision, prior uterine rupture, or extensive transfundal uterine surgery, multiple gestations, and those in whom vaginal delivery is otherwise contraindicated (e.g, those with placenta previa) .
Two authors (YW and YK) examined studies on the basis of inclusion and exclusion. Studies were initially reviewed on titles and abstracts, and those deemed relevant were reviewed in full text. Disparities in selection were resolved through discussion and ultimately by the third reviewer (CE). In cases of study duplication, the more recent studies were selected for inclusion. Data were extracted by two authors (YW and YK) to verify the accuracy.
Assessment of risk of bias
The quality of each study was evaluated and scored independently by two authors (YW and CE) using the nine-star Newcastle-Ottawa Scale (NOS). Studies were evaluated based on selection, comparability, exposure, and outcome, and scored by a maximum of nine points. Scores above five indicate moderate to high study quality. The NOS for cohort and case-control studies was retrieved from: http://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf.
From each study, we extracted or estimated the odds ratio (OR) for each factor and outcome of interest, with the 95% confidence intervals (CI). We also extracted mean and SD for continuous variables of each factor. We used the statistical program Stata 14.0 and the commands “metan” to calculate random effects summary estimates. For continuous variables we used standardized mean differences (SMD) with 95% CI. For binary variables, we used ORs and 95% CIs. Statistical heterogeneity was assessed graphically with forest plots and statistically using Cochran’s Q-statistic and the I2 value. Publication bias was measured by Egger’s test and by visually assessing funnel plots. YW and CE were responsible for the data synthesis.
Ninety-four studies were ultimately included in our analysis [9, 14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106]. The study selection process is shown in Additional file 1: Figure S1. A total of 94 studies were included in our analysis. Twenty-eight were prospective cohort studies, and 66 were retrospective observational studies. No randomized trials were identified. The number of women in the included studies ranged from 28 to 75,086 (Additional file 18: Table S1). Details of the selected studies and the data extracted from each study were shown in Additional file 19: Table S2. The Newcastle–Ottawa Scale revealed a score of 7–8 in case-control studies and 6–9 in cohort studies (Additional file 20: Table S3). In total, 239,006 women who attempted a TOLAC were included; the successful rate of VBAC was 68.4%. Compare to the other continents (Additional file 2: Figure S2), women in African region achieved the lowest successful rate (54.1%) of VBAC (P < 0.05).
Continuous variable differences of maternal and fetal factors between successful VABC and failed VBAC are shown in Fig. 1. The associations of maternal and fetal factors with the success of VBAC are shown in Fig. 2.
Significant SMD of factors for VBAC were the following: BMI (SMD,-0.30; 95% CI: − 0.38, − 0.23) (Additional file 3: Figure S3), Bishop score (SMD, 0.76; 95% CI: 0.48, 1.05) (Additional file 5: Figure S5A), birth weight (SMD,-0.24; 95% CI: − 0.30, − 0.18) (Additional file 6: Figure S6A).
Factors associated with statistically significant increased likelihood of VBAC were the following: previous VB before CS (OR, 3.14; 95% CI, 2.62–3.77; adjusted OR, 3.00; 95% CI, 2.27–3.95) (Additional file 7: Figure S7A and S7B), previous VBAC (OR, 4.71; 95% CI, 4.33–5.12; adjusted OR, 4.04; 95% CI, 2.52–6.49) (Additional file 8: Figure S8A and S8B), Bishop score at admission before delivery (OR, 3.77; 95% CI, 2.17–6.53; adjusted OR, 2.99; 95% CI, 1.88–4.75) (Additional file 5: Figure S5B and S5C), fetal malpresentation as the indication for previous CS (OR, 1.66; 95% CI, 1.38–2.01) (Additional file 9: Figure S9D), and White race (OR, 1.39; 95% CI, 1.26–1.54) (Additional file 10: Figure S10A).
Risk factors associated with statistically significant decreased likelihood of VBAC were the following: Age (OR, 0.92; 95% CI, 0.86–0.98; adjusted OR, 0.85; 95% CI, 0.78–0.92) (Additional file 11: Figure S11B and S11C), BMI (OR, 0.63; 95% CI, 0.53–0.74; adjusted OR, 0.94; 95% CI, 0.91–0.98) (Fig. 3 and Additional file 4: Figure S4), diabetes (OR, 0.50; 95% CI, 0.42–0.60) (Fig. 4), HDCP (OR, 0.54; 95% CI, 0.44–0.67; adjusted OR, 0.70; 95% CI, 0.57–0.87) (Fig. 5 and Additional file 12: Figure S12), macrosomia (OR, 0.56; 95% CI, 0.50–0.64; adjusted OR, 0.53; 95% CI, 0.49–0.59) (Additional file 6: Figure S6B and S6C), labor induction (OR, 0.58; 95% CI, 0.50–0.67; adjusted OR, 0.57; 95% CI, 0.46–0.70) (Additional file 13: Figure S13A and S13B), Black race compared to the White (OR, 0.54; 95% CI, 0.19–1.54; adjusted OR, 0.51; 95% CI, 0.44–0.60) (Additional file 10: Figure S10B and S10C), Asian race compared to the White (OR, 0.67; 95% CI, 0.50–0.90; adjusted OR, 0.72; 95% CI, 0.58–0.90) (Additional file 10: Figure S10B and S10C), Latina race compared to the White (OR, 0.71; 95% CI, 0.56–0.89; adjusted OR, 0.70; 95% CI, 0.50–1.00) (Additional file 10: Figure S10B and S10C), and the indications for previous CS such as cephalopelvic disproportion (CPD) (OR, 0.54; 95% CI, 0.36–0.80) (Additional file 9: Figure S9A), dystocia or failure to progress (OR, 0.54; 95% CI, 0.41–0.70; adjusted OR, 0.33; 95% CI, 0.27–0.40) (Additional file 9: Figure S9B and S9E), and failed induction (OR, 0.56; 95% CI, 0.37–0.85) (Additional file 9: Figure S9A).
Factors not associated with likelihood of VBAC were the following: smoke (OR, 1.11; 95% CI, 0.97–1.27) (Additional file 14: Figure S14), interdelivery interval (OR, 1.24; 95% CI, 0.99–1.55; adjusted OR, 0.99; 95% CI, 0.83–1.19) (Additional file 15: Figure S15B and S15C), gestational weeks (OR, 0.84; 95% CI, 0.63–1.12; adjusted OR, 0.95; 95% CI, 0.85–1.06) (Additional file 16: Figure S16B and S16C), epidural anesthesia (OR, 0.71; 95% CI, 0.33–1.54) (Additional file 17: Figure S17), and the indications for previous CS (fetal distress (OR, 1.01; 95% CI, 0.87–1.17) (Additional file 9: Figure S9C), HDCP (OR, 0.71; 95% CI, 0.29–1.75) (Additional file 9: Figure S9A), and suspected fetal macrosomia (OR, 0.56; 95% CI, 0.30--1.04) (Additional file 9: Figure S9A).
We also performed the analysis by subgroup for age, BMI, diabetes, and HDCP. Advanced age (age ≥ 35 years-old) is associated with VBAC failure (OR, 0.97; 95% CI, 0.85–1.11; adjusted OR, 0.75; 95% CI, 0.65–0.86) (Additional file 11: Figure S11B and S11C). Pre-pregnancy BMI, BMI at first prenatal visit or BMI at admission before delivery of women with successful VBAC were lower than those of women with failed VBAC (Additional file 3: Figure S3). Obesity (BMI ≥ 30 kg/m2) was a risk factor for failed VBAC (OR, 0.50; 95% CI, 0.39–0.64) (Fig. 3). Both pre-existing diabetes (OR, 0.42; 95% CI, 0.33–0.55) and gestational diabetes mellitus (GDM) (OR, 0.53; 95% CI, 0.43–0.66) were identified as risk factors for failed VBAC (Fig. 4). The trends were similar in chronic/pregnancy-induced hypertension (OR, 0.62; 95% CI, 0.46–0.83) and preeclampsia/eclampsia (OR, 0.50; 95% CI, 0.36–0.69) (Fig. 4).
Heterogeneity and publication Bias and sensitivity analysis
Almost all point estimates were in the same direction, and I2 heterogeneity < 50% was detected in the following meta-analysis: OR and adjusted OR of advanced age, SMD of BMI (pre-pregnancy or at admission before delivery), OR of pre-existing diabetes, adjusted OR of HDCP, adjusted OR of macrosomia, OR and adjusted OR of previous VBAC, adjusted OR of Black race, adjusted OR of Asian race, adjusted OR of Latina race, OR of Bishop score, adjusted OR of gestational weeks, and OR of indications for previous CS (such as CPD, failed induction, and suspected fetal macrosomia). The rest of the meta-analyses had either point estimates in both directions or I2 heterogeneity > 50%. If I2 heterogeneity > 50% and P-value < 0.05, the meta-analysis was stratified by study size, location and study design. After stratifying by subgroup, most I2 heterogeneities became lower (Additional file 21: Table S4). Except for the SMD of age and OR of BMI, there was no evidence of publication bias in the meta-analysis (Figs. 1 and 2).
Based on the meta-analyses, the following factors were associated with a successful VBAC: previous VB before CS, previous VBAC, White race, higher bishop score, and fetal malpresentation as the indication for previous CS. The following factors were associated with an unsuccessful VBAC: advanced age, obesity, diabetes, HDCP, non-white race, macrosomia, labor induction, and CPD, dystocia or FTP, failed induction as the indications for previous CS. The following factors are not statistically associated with VBAC success: smoke, interdelivery interval, gestational weeks, epidural anesthesia during labor, and the indications for previous CS (fetal distress, HDCP, and suspected fetal macrosomia).
Understanding the influences of factors on VBAC could provide sufficient evidence to assess chances for achieving a successful vaginal delivery among women with prior CS. It also could help the clinician provide evidence-based counseling about VBAC, which has important implications on avoiding repeated CS. The evidence quality was considered moderate on the Newcastle-Ottawa Scale.
Strengths and limitations
This meta-analysis is the most recent that comprehensively, critically, and quantitatively assesses the association between maternal or fetal factors and the chances for achieving a successful VBAC, including factors both from the historical and current pregnancies. It is also the first large study to specifically evaluate the association between obesity, diabetes, HDCP, gestational weeks, interdelivery interval and VBAC success. However, this study has limitations. First, there might be pertinent studies that were not identified owing to inherent limitations in database literature searches. Second, the quality of evidence is limited by data largely derived from retrospective observational analyses, with heterogeneous data reporting and study design. Third, after subgroup analyzed by study size, location, and study design, I2 heterogeneity was still high in some meta-analysis, which might result from the change of the guidelines on VBAC or guidelines varying in different countries. Forth, there was publication bias in the meta-analyses of the SMD of age and the OR of BMI, which might be because positive results are more likely to be published compared to null studies and almost these studies showed the similar trends of the factors related to VBAC. Five, some studies did not present adjusted OR; however, the pooled unadjusted OR was similar to the adjusted OR.
Historic maternal and fetal factors
Having experienced a vaginal birth (VB), either before CS or after CS, tripled the success rates of VBAC. Moreover, the previous VBAC was a stronger predictor of success than previous VB before CS. These findings can further confirm that the history of past vaginal deliveries is of the utmost importance. Previous VB also related to the lower rate of uterine rupture .
Indications for previous CS have important implications for the chance for VBAC. CPD, dystocia or failure to progress, failed induction, and suspected fetal macrosomia were risk factors for failed VBAC. Although the above conditions might not be present in the next pregnancy, the indications for previous CS could help us to identify the VBAC candidates.
Current maternal and fetal factors
Increased age decreases the likelihood of VBAC. Women with advanced age were more likely to fail to VBAC, which was also supported by Eden et al.  Age ≥ 40 years-old was also a risk for uterine rupture when women undertook TOLAC . So, younger women, especially those < 35-years-old, are more likely to have a successful and safe VBAC.
Maternal obesity carries the risk for many obstetric complications including macrosomia and increased risk of CS . Both obesity and macrosomia have negative impacts on VBAC success. When comparing cases where obesity occurred at pre-pregnancy or at admission before delivery, the trends are similar. Faucett et al. found that women with obesity were more likely to undergo emergency cesarean for an arrest disorder before achieving active labor despite having more clinical interventions to achieve a vaginal birth . A better understanding of the mechanisms by which maternal obesity affects the progression of labor, might help to increase the rates of successful VBAC among this population. Maternal obesity was also associated with a high risk of uterine dehiscence or rupture at term gestation among women with previous CS . Therefore, appropriate weight and weight gain during pregnancy are vital for maternal health.
Gestational and pregestational diabetes are risk factors for VBAC failure. Diabetic women could be at high risk of CS secondary to failed induction, labor arrest, and fetal distress . Furthermore, pregnant women with diabetes are more likely to have increased BMI and weight gain, both of which have a negative influence on VBAC success. Prevent and control diabetes could help to increase the likelihood of VBAC.
HDCP has a negative impact on the VBAC success. HDCP could cause maternal vasospasm, which results in placental damage and relative insufficiency, leading to intrauterine fetal growth restriction (IUGR). These changes in vascular physiology could predispose women to a VBAC failure due to nonreassuring fetal status . Fortunately, it was found that HDCP did not increase the risk of uterine rupture .
Our results show that interdelivery interval is not associated with a VBAC success. The interdelivery interval shorter than 24 months doesn’t relate to VBAC failure. However, there is only one study reporting the association between the interdelivery interval shorter than 18 months and the likelihood of VBAC , so we couldn’t conduct a meta-analysis to make sure whether the interval shorter than 18 months is a risk for failed VBAC.
Compared to spontaneous labor, induction of labor is more likely to decrease the likelihood of VBAC. However, an unfavorable cervix also decreases the chance of VBAC success. Whether to perform induction of labor and when to do it are the questions we meet in clinical practice. Our results showed that the gestational week at delivery is not associated to the VBAC success, whether the cut-off point was 37 gestational weeks, 40 gestational weeks or 41 gestational weeks. One recent study revealed that induction of labor at 39 gestational weeks could increase the chance of VBAC compared to expectant management , but also of uterine rupture. Thus, we should consider both benefits and harms to perform induction of labor for appropriate VBAC candidates. Gestational week might not serve as an argument for or against VBAC.
Smoke and epidural anesthesia are not associated with the chance of VBAC in our study. However, smoke could increase susceptibility for nonreassuring fetal heart rate, especially in the second stage of labor, leading to higher rate of instrumental delivery . Pain relief during labor makes women more likely to choose TOLAC. However, epidural anesthesia could also relieve the pain caused by uterine rupture, which clinicians should be highly aware of.
During the prenatal counseling of women with one previous cesarean section, the probability of successful vaginal birth is one of the most crucial factors. The history of previous delivery (previous VB before CS, previous VBAC and the indications for previous CS), the characteristics of the pregnant women (age and race), the complications (obesity, diabetes and HDCP), the size of the fetus, the bishop score of the cervix, and the necessity of labor induction should be highly considered, which were associated to the success of VBAC. The clinicians should be also aware that uterine rupture could complicate with TOLAC. TOLAC under continuous monitoring by a skilled clinician and at facilities with 24-h surgery services  should be guaranteed to increase the safety of the delivery.
Our results find that age, obesity, diabetes, HDCP, Bishop score, labor induction, birth weight, previous vaginal birth, and the indications for the previous CS should be considered as the factors related to the success of VBAC. This meta-analysis provides the most comprehensive review of previously reported maternal and fetal factors for the chance of VBAC. We believe that the results are important for women who are pregnant or are planning to become pregnant after a previous CS.
Availability of data and materials
All data analyzed during this study are included in this published article and its supplementary information files.
Body mass index
Hypertensive disorders complicating pregnancy
Standardized mean differences
Trial of labor after cesarean
Vaginal birth after cesarean section
World Health Organization
Joyce A, Martin MPH, Hamilton PD BE, Osterman MHS MJK. Births in the United States, 2016. NCHS Data Brief. 2017;287:1–8.
World Health Organization Human Reproduction Programme A. WHO statement on caesarean section rates. Reprod Health Matters. 2015;23(45):149–50.
Cheng YW, Eden KB, Marshall N, Pereira L, Caughey AB, Guise JM. Delivery after prior cesarean: maternal morbidity and mortality. Clin Perinatol. 2011;38(2):297–309.
Bellows P, Shah U, Hawley L, Drexler K, Gandhi M, Sangi-Haghpeykar H, Davidson C. Evaluation of outcomes associated with trial of labor after cesarean delivery after a change in clinical practice guidelines in an academic hospital. J Matern Fetal Neonatal Med. 2017;30(17):2092–6.
RCOG: Birth after Previous Caesarean Birth (Green-top Guideline No. 45). Green-top Guideline No 45 October 2015. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/q=Birth+after+previous+caesarean+birth+&subject=&type=Green-top+Guidelines&orderby=title. (Green-top Guideline No. 45 October 2015).
Foureur M, Ryan CL, Nicholl M, Homer C. Inconsistent evidence: analysis of six national guidelines for vaginal birth after cesarean section. Birth. 2010;37(1):3–10.
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 Syst Rev. 2013;12:CD004224.
Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581–9.
Knight HE, Gurol-Urganci I, van der Meulen JH, Mahmood TA, Richmond DH, Dougall A, Cromwell DA. Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success. BJOG. 2014;121(2):183–92.
McMahon MJ, Luther ER, Bowes WA Jr, Olshan AF. Comparison of a trial of labor with an elective second cesarean section. N Engl J Med. 1996;335(10):689–95.
Eden KB, McDonagh M, Denman MA, Marshall N, Emeis C, Fu R, Janik R, Walker M, Guise JM. New insights on vaginal birth after cesarean: can it be predicted? Obstet Gynecol. 2010;116(4):967–81.
Rosen MG, Dickinson JC. Vaginal birth after cesarean: a meta-analysis of indicators for success. Obstet Gynecol. 1990;76(5 Pt 1):865–9.
Bulletins-Obstetrics. CoP: Practice Bulletin No. 184 vaginal birth after cesarean delivery. Obstet Gynecol. 2017;130(5):e217–33.
Beloosesky R, Khatib N, Ganem N, Matanes E, Ginsberg Y, Divon M, Weiner Z. Cervical length measured before delivery and the success rate of vaginal birth after cesarean (VBAC). J Matern Fetal Neonatal Med. 2018;31(4):464–8.
Fox NS, Namath AG, Ali M, Naqvi M, Gupta S, Rebarber A. Vaginal birth after a cesarean delivery for arrest of descent. J Matern Fetal Neonatal Med. 2018:1–5.
Wen J, Song X, Ding H, Shen X, Shen R, Hu LQ, Long W. Prediction of vaginal birth after cesarean delivery in Chinese parturients. Sci Rep. 2018;8(1):3084.
Krispin E, Hiersch L, Wilk Goldsher Y, Wiznitzer A, Yogev Y, Ashwal E. Association between prior vaginal birth after cesarean and subsequent labor outcome. J Matern Fetal Neonatal Med. 2018;31(8):1066–72.
Kalisa R, Rulisa S, van Roosmalen J, van den Akker T. Maternal and perinatal outcome after previous caesarean section in rural Rwanda. BMC Pregnancy Childbirth. 2017;17(1):272.
Mizrachi Y, Barber E, Kovo M, Bar J, Lurie S. Prediction of vaginal birth after one ceasarean delivery for non-progressive labor. Arch Gynecol Obstet. 2018;297(1):85–91.
Tsai HT, Wu CH. Vaginal birth after cesarean section-the world trend and local experience in Taiwan. Taiwan J Obstet Gynecol. 2017;56(1):41–5.
McDonald ACE, Wise MR, Thompson JM. Effect of excessive gestational weight gain on trial of labour after caesarean: a retrospective cohort study. Aust N Z J Obstet Gynaecol. 2018;58(1):64–71.
De Bonrostro TC, Tejero Cabrejas EL, Marti Gamboa S, Lapresta Moros M, Campillos Maza JM, Castan Mateo S. Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice? Arch Gynecol Obstet. 2017;295(5):1135–43.
Maykin MM, Mularz AJ, Lee LK, Valderramos SG. Validation of a prediction model for vaginal birth after cesarean delivery reveals unexpected success in a diverse American population. AJP Rep. 2017;7(1):e31–8.
Patel MD, Maitra N, Patel PK, Sheth T, Vaishnav P. Predicting successful trial of labor after cesarean delivery: evaluation of two scoring systems. J Obstet Gynaecol India. 2018;68(4):276–82.
Nakamura K, Hayashi S, Sasahara J, Okamoto Y, Ishii K, Mitsuda N. Labor after cesarean delivery managed without induction or augmentation of labor. Birth. 2017;44(4):363–8.
Kalok A, Zabil SA, Jamil MA, Lim PS, Shafiee MN, Kampan N, Shah SA, Mohamed Ismail NA. Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section. J Obstet Gynaecol. 2018;38(3):339–43.
Abreu-Silva J, Castro J, Maia C, Pinho M, Carvalho C. Trial of labour after caesarean section: two-year analysis at a Portuguese Centre. J Obstet Gynaecol. 2017;37(6):704–8.
Wassan Yassen A, Nawal D. Factors influencing successful vaginal birth after cesarean delivery. Bahrain Med Bull. 2017;39(1):24-8.
Haumonte JB, Raylet M, Christophe M, Mauviel F, Bertrand A, Desbriere R, d'Ercole C. French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery. J Gynecol Obstet Hum Reprod. 2018;47(3):127–31.
Ganer Herman H, Kogan Z, Bar J, Kovo M. Trial of labor after cesarean delivery for pregnancies complicated by gestational diabetes mellitus. Int J Gynaecol Obstet. 2017;138(1):84–8.
Mirteymouri M, Ayati S, Pourali L, Mahmoodinia M, Mahmoodinia M. Evaluation of maternal-neonatal outcomes in vaginal birth after cesarean delivery referred to maternity of academic hospitals. J Family Reprod Health. 2016;10(4):206–10.
Black M, Bhattacharya S, Philip S, Norman JE, McLernon DJ. Planned repeat cesarean section at term and adverse childhood health outcomes: a record-linkage study. PLoS Med. 2016;13(3):e1001973.
Annessi E, Del Giovane C, Magnani L, Carossino E, Baldoni G, Battagliarin G, Accorsi P, Fabio F. A modified prediction model for VBAC, in a European population. J Matern Fetal Neonatal Med. 2016;29(3):435–9.
Gonsalves H, Al-Riyami N, Al-Dughaishi T, Gowri V, Al-Azri M, Salahuddin A. Use of intracervical Foley catheter for induction of labour in cases of previous caesarean section: experience of a single tertiary Centre in Oman. Sultan Qaboos Univ Med J. 2016;16(4):e445–50.
Nkwabong E, Fomulu JN, Djomkam Youmsi FL. Trial of labor after cesarean section among women with unique lower segment scarred uterus and fetal weight >3500 g: prognostic factors for a safe vaginal delivery. J Obstet Gynaecol India. 2016;66(Suppl 1):202–6.
Khan B, Deeba F, Bashir R, Khan W. Out come of trial of scar in patients with previous caesarean section. J Ayub Med Coll Abbottabad. 2016;28(3):587–90.
Comas M, Cochs B, Marti L, Ruiz R, Maireles S, Costa J, Canet Y. Ultrasound examination at term for predicting the outcome of delivery in women with a previous cesarean section. J Matern Fetal Neonatal Med. 2016;29(23):3870–4.
Miller ES, Sakowicz A, Donelan EA, Grobman WA. Does midtrimester cervical length aid in predicting vaginal birth after cesarean? Am J Obstet Gynecol. 2015;212(6):791.e791–4.
Ashwal E, Wertheimer A, Aviram A, Wiznitzer A, Yogev Y, Hiersch L. Prediction of successful trial of labor after cesarean - the benefit of prior vaginal delivery. J Matern Fetal Neonatal Med. 2016;29(16):2665–70.
Senturk MB, Cakmak Y, Atac H, Budak MS. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia. Int J Women's Health. 2015;7:693–7.
Singh N, Tripathi R, Mala YM, Dixit R. Scar thickness measurement by transvaginal sonography in late second trimester and third trimester in pregnant patients with previous cesarean section: does sequential change in scar thickness with gestational age correlate with mode of delivery? J Ultrasound. 2015;18(2):173–8.
Facchinetti F, Del Giovane C, Petrella E, Annessi E. Induction of labor in women that had a previous cesarean delivery. J Matern Fetal Neonatal Med. 2015;28(1):55–8.
Regan J, Keup C, Wolfe K, Snyder C, DeFranco E. Vaginal birth after cesarean success in high-risk women: a population-based study. J Perinatol. 2015;35(4):252–7.
Soni A, Sharma C, Verma S, Justa U, Soni PK, Verma A. A prospective observational study of trial of labor after cesarean in rural India. Int J Gynaecol Obstet. 2015;129(2):156–60.
Balachandran L, Vaswani PR, Mogotlane R. Pregnancy outcome in women with previous one cesarean section. J Clin Diagn Res. 2014;8(2):99–102.
Gupta S, Jeeyaselan S, Guleria R, Gupta A. An observational study of various predictors of success of vaginal delivery following a previous cesarean section. J Obstet Gynaecol India. 2014;64(4):260–4.
Ugwu GO, Iyoke CA, Onah HE, Egwuatu VE, Ezugwu FO. Maternal and perinatal outcomes of delivery after a previous cesarean section in Enugu, Southeast Nigeria: a prospective observational study. Int J Women's Health. 2014;6:301–5.
Shaheen N, Khalil S, Iftikhar P. Prediction of successful trial of labour in patients with a previous caesarean section. J Pak Med Assoc. 2014;64(5):542–5.
Damle LF, Wilson K, Huang CC, Landy HJ, Gomez-Lobo V. Do they stand a chance? Vaginal birth after cesarean section in adolescents compared to adult women. J Pediatr Adolesc Gynecol. 2015;28(4):219–23.
Sananes N, Rodriguez M, Stora C, Pinton A, Fritz G, Gaudineau A, Aissi G, Boudier E, Viville B, Favre R, et al. Efficacy and safety of labour induction in patients with a single previous caesarean section: a proposal for a clinical protocol. Arch Gynecol Obstet. 2014;290(4):669–76.
Melamed N, Segev M, Hadar E, Peled Y, Wiznitzer A, Yogev Y. Outcome of trial of labor after cesarean section in women with past failed operative vaginal delivery. Am J Obstet Gynecol. 2013;209(1):49.e41–7.
Metz TD, Stoddard GJ, Henry E, Jackson M, Holmgren C, Esplin S. Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission. Obstet Gynecol. 2013;122(3):571–8.
Siddiqui SA. Obstetric factors for unsuccessful trial of labor in second-order birth following previous cesarean. Ann Saudi Med. 2013;33(4):356–62.
Birara M, Gebrehiwot Y. Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: a case control study. BMC Pregnancy Childbirth. 2013;13:31.
Naji O, Wynants L, Smith A, Abdallah Y, Stalder C, Sayasneh A, McIndoe A, Ghaem-Maghami S, Van Huffel S, Van Calster B, et al. Predicting successful vaginal birth after cesarean section using a model based on cesarean scar features examined by transvaginal sonography. Ultrasound Obstet Gynecol. 2013;41(6):672–8.
Schoorel EN, van Kuijk SM, Melman S, Nijhuis JG, Smits LJ, Aardenburg R, de Boer K, Delemarre FM, van Dooren IM, Franssen MT, et al. Vaginal birth after a caesarean section: the development of a Western European population-based prediction model for deliveries at term. BJOG. 2014;121(2):194–201 discussion 201.
Obeidat N, Meri ZB, Obeidat M, Khader Y, Al-Khateeb M, Zayed F, Alchalabi H, Kriesat W, Lataifeh I. Vaginal birth after caesarean section (VBAC) in women with spontaneous labour: predictors of success. J Obstet Gynaecol. 2013;33(5):474–8.
Yokoi A, Ishikawa K, Miyazaki K, Yoshida K, Furuhashi M, Tamakoshi K. Validation of the prediction model for success of vaginal birth after cesarean delivery in Japanese women. Int J Med Sci. 2012;9(6):488–91.
Erez O, Novack L, Kleitman-Meir V, Dukler D, Erez-Weiss I, Gotsch F, Mazor M. Remote prognosis after primary cesarean delivery: the association of VBACs and recurrent cesarean deliveries with maternal morbidity. Int J Women's Health. 2012;4:93–107.
Ouzounian JG, Miller DA, Hiebert CJ, Battista LR, Lee RH. Vaginal birth after cesarean section: risk of uterine rupture with labor induction. Am J Perinatol. 2011;28(8):593–6.
Puri P, Abraham M, Grover S. Vaginal birth after one previous lower segment caesarean section. JK Sci. 2011;13:4:179-81.
Madaan M, Agrawal S, Nigam A, Aggarwal R, Trivedi SS. Trial of labour after previous caesarean section: the predictive factors affecting outcome. J Obstet Gynaecol. 2011;31(3):224–8.
Wanyonyi SZ, Karuga RN. The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation. BMC Pregnancy Childbirth. 2010;10:62.
Oboro V, Adewunmi A, Ande A, Olagbuji B, Ezeanochie M, Oyeniran A. Morbidity associated with failed vaginal birth after cesarean section. Acta Obstet Gynecol Scand. 2010;89(9):1229–32.
Olagbuji B, Ezeanochie M, Okonofua F. Predictors of successful vaginal delivery after previous caesarean section in a Nigerian tertiary hospital. J Obstet Gynaecol. 2010;30(6):582–5.
Kwon JY, Jo YS, Lee GS, Kim SJ, Shin JC, Lee Y. Cervical dilatation at the time of cesarean section may affect the success of a subsequent vaginal delivery. J Matern Fetal Neonatal Med. 2009;22(11):1057–62.
Olusanya BO, Solanke OA. Adverse neonatal outcomes associated with trial of labor after previous cesarean delivery in an inner-city hospital in Lagos, Nigeria. Int J Gynaecol Obstet. 2009;107(2):135–9.
Hollard AL, Wing DA, Chung JH, Rumney PJ, Saul L, Nageotte MP, Lagrew D. Ethnic disparity in the success of vaginal birth after cesarean delivery. J Matern Fetal Neonatal Med. 2006;19(8):483–7.
Jerbi M, Hidar S, Ammar A, Khairi H. Predictive factors of vaginal birth after cesarean delivery. Int J Gynaecol Obstet. 2006;94(1):43–4.
Srinivas SK, Stamilio DM, Stevens EJ, Peipert JF, Odibo AO, Macones GA. Safety and success of vaginal birth after cesarean delivery in patients with preeclampsia. Am J Perinatol. 2006;23(3):145–52.
Smith GC, White IR, Pell JP, Dobbie R. Predicting cesarean section and uterine rupture among women attempting vaginal birth after prior cesarean section. PLoS Med. 2005;2(9):e252.
Pathadey SD, Van Woerden HC, Jenkinson SD. Induction of labour after a previous caesarean section: a retrospective study in a district general hospital. J Obstet Gynaecol. 2005;25(7):662–5.
Landon MB, Leindecker S, Spong CY, Hauth JC, Bloom S, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, et al. The MFMU cesarean registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol. 2005;193(3 Pt 2):1016–23.
Bujold E, Hammoud A, Schild C, Krapp M, Baumann P. The role of maternal body mass index in outcomes of vaginal births after cesarean. Am J Obstet Gynecol. 2005;193(4):1517–21.
Cameron CA, Roberts CL, Peat B. Predictors of labor and vaginal birth after cesarean section. Int J Gynaecol Obstet. 2004;85(3):267–9.
Gonen R, Tamir A, Degani S, Ohel G. Variables associated with successful vaginal birth after one cesarean section: a proposed vaginal birth after cesarean section score. Am J Perinatol. 2004;21(8):447–53.
Tripathi JB, Doshi HU, Kotdawala PJ. Vaginal birth after one caesarean section: analysis of indicators of success. J Indian Med Assoc. 2006;104(3):113–5.
Marchiano D, Elkousy M, Stevens E, Peipert J, Macones G. Diet-controlled gestational diabetes mellitus does not influence the success rates for vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2004;190(3):790–6.
Bujold E, Blackwell SC, Hendler I, Berman S, Sorokin Y, Gauthier RJ. Modified Bishop’s score and induction of labor in patients with a previous cesarean delivery. Am J Obstet Gynecol. 2004;191(5):1644–8.
Gyamfi C, Juhasz G, Gyamfi P, Stone JL. Increased success of trial of labor after previous vaginal birth after cesarean. Obstet Gynecol. 2004;104(4):715–9.
Grinstead J, Grobman WA. Induction of labor after one prior cesarean: predictors of vaginal delivery. Obstet Gynecol. 2004;103(3):534–8.
Dinsmoor MJ, Brock EL. Predicting failed trial of labor after primary cesarean delivery. Obstet Gynecol. 2004;103(2):282–6.
Durnwald CP, Ehrenberg HM, Mercer BM. The impact of maternal obesity and weight gain on vaginal birth after cesarean section success. Am J Obstet Gynecol. 2004;191(3):954–7.
Dadhwal V, Mittal S, Kumar S, Anandlakshmi PN, Vimala N. Vaginal birth after cesarean delivery: Variables affecting outcome. JK Sci. 2003;5:1:11-4.
Wong KS, Wong AYK, Tse LHY, Tang LCH. Use of fetal-pelvic index in the prediction of vaginal birth following previous cesarean section. J Obstet Gynaecol Res. 2003;29:2(104-108).
Coleman TL, Randall H, Graves W, Lindsay M. Vaginal birth after cesarean among women with gestational diabetes. Am J Obstet Gynecol. 2001;184(6):1104–7.
McNally OM, Turner MJ. Induction of labour after 1 previous Caesarean section. Aust N Z J Obstet Gynaecol. 1999;39(4):425-9.
Rageth JC, Juzi C, Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Swiss working Group of Obstetric and Gynecologic Institutions. Obstet Gynecol. 1999;93(3):332–7.
Caughey AB, Shipp TD, Repke JT, Zelop C, Cohen A, Lieherman E. Trial of labor after cesarean delivery: the effect of previous vaginal delivery. Am J Obstet Gynecol. 1998;179(4):938–41.
Obara H, Minakami H, Koike T, Takamizawa S, Matsubara S, Sato I. Vaginal birth after cesarean delivery: results in 310 pregnancies. J Obstet Gynaecol Res. 1998;24(2):129–34.
Ilesanmi AO, Odukogbe A, Olaleye DO. Vaginal delivery after one caesarean section in Nigerian women. J Obstet Gynaecol. 1997;17(2):139–42.
Perveen F, Shah Q. Obstetric Outcome after One Previous Ceasarean Section. J obstet Gynaecol Res. 1997;23(4):341–6.
Holt VL, Mueller BA. Attempt and success rates for vaginal birth after caesarean section in relation to complications of the previous pregnancy. Paediatr Perinat Epidemiol. 1997;11(Suppl 1):63–72.
Weinstein D, Benshushan A, Tanos V, Zilberstein R, Rojansky N. Predictive score for vaginal birth after cesarean section. Am J Obstet Gynecol. 1996;174(1 Pt 1):192–8.
Lovell R. Vaginal delivery after caesarean section: factors influencing success rates. Aust N Z J Obstet Gynaecol. 1996;36(1):4–8.
Thomas M, Khan GQ. Outcome of pregnancy in patients with one previous caesarean section. J Obstet Gynaecol. 2009;14(6):416–9.
Wasti S, Turab A, Agha Z, Qazi F, Hussany F, Farid H, Rizvi JH. An audit of labour following Caesarean section at the Aga Khan Medical Centre. Aust N Z J Obstet Gynaecol. 1994;34(5):527.
Yasumizu T, Nozawa A, Kinoshita T, Kato J. Trial of vaginal birth following cesarean section for arrest disorders of labor: analysis of patients with well-documented medical records. Asia Oceania J Obstet Gynaecol. 1994;20(4):407–13.
Paterson CM, Saunders NJ. Mode of delivery after one caesarean section: audit of current practice in a health region. BMJ. 1991;303(6806):818–21.
Bhide A, Caric V, Arulkumaran S. Prediction of vaginal birth after cesarean delivery. Int J Gynaecol Obstet. 2016;133(3):297–300.
Tasleem H, Ghazanfar H. Trial of labor after previous cesarean delivery (TOLAC) and association of BMI and previous vaginal delivery with frequency of VBAC. Bangladesh J Med Sci. 2016;15(4):546–50.
Negara IKS, Sujana GAH: Vaginal Birth After Cesarean Characteristics with Maternal and Perinatal Out Come in Sanglah Hospital, Bali, 1st January 2015 to 31st December 2016 Period: A Descriptive Study. J Global Pharma Technol 2017, 03(9):61–67(0975–8542).
Faiz SA, Iqbal J, Yaqoob S. Trial of labor after cesarean delivery: a two year experience. Rawal Med J. 2017;42:231–4.
Khanumm S, Khanum A. The frequency of vaginal birth after one cesarean section with vigilant fetal and maternal monitoring. Pakistan J Med Health Sci. 2011;5:3(455-456).
Puliyath G. Vaginal birth after caesarean section (VBAC)- A descriptive study from middle east. The Internet Journal of Gynecology and Obstetrics 2009, 12(2).
Huang WH, Nakashima DK, Rumney PJ, Keegan KA Jr, Chan K. Interdelivery interval and the success of vaginal birth after cesarean delivery. Obstet Gynecol. 2002;99(1):41–4.
Hidalgo-Lopezosa P, Hidalgo-Maestre M. Risk of uterine rupture in vaginal birth after cesarean: systematic review. Enfermeria Clinica. 2017;27(1):28–39.
Wu Y, Ming WK, Wang D, Chen H, Li Z, Wang Z. Using appropriate pre-pregnancy body mass index cut points for obesity in the Chinese population: a retrospective cohort study. Reprod Biology Endocrinol. 2018;16(1):77.
Faucett AM, Allshouse AA, Donnelly M, Metz TD. Do obese women receive the necessary interventions to achieve vaginal birth after cesarean? Am J Perinatol. 2016;33(10):991–7.
Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, Varner MW, Caritis SN, Harper M, Wapner RJ, et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol. 2006;108(1):125–33.
Juhasz G, Gyamfi C, Gyamfi P, Tocce K, Stone JL. Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery. Obstet Gynecol. 2005;106(4):741–6.
Palatnik A, Grobman WA. Induction of labor versus expectant management for women with a prior cesarean delivery. Am J Obstet Gynecol. 2015;212(3):358.e351–6.
Lurie S, Ribenzaft S, Boaz M, Golan A, Sadan O. The effect of cigarette smoking during pregnancy on mode of delivery in uncomplicated term singleton pregnancies. J Matern Fetal Neonatal Med. 2014;27(8):812–5.
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Selection of studies (JPG 101 kb)
Successful rates of VBAC among different continents. *P < 0.001; **P < 0.01; ***P < 0.001; ****P = 0.135 (JPG 56 kb)
BMI associated with VBAC success - Standardized mean differences. (JPG 142 kb)
BMI associated with VBAC success - Adjusted odds ratio. (JPG 114 kb)
Association between Bishop score and VBAC. (A) Standardized mean differences; (B) Odds ratio; (C) Adjusted odds ratio. (JPG 114 kb)
Birth weight associated with VBAC success. (A) Standardized mean differences; (B) Odds ratio; (C) Adjusted odds ratio. (JPG 171 kb)
Previous vaginal birth before CS associated with VBAC success. (A) Odds ratio; (B) Adjusted odds ratio. (JPG 144 kb)
Previous VBAC associated with VBAC success. (A) Odds ratio; (B) Adjusted odds ratio. (JPG 83 kb)
Association between indication for previous CS and VBAC. (A) Association of suspected fetal macrosomia, failed induction, cephalopelvic disproportion, and hypertensive disorders complicating pregnancy as the indication for Previous CS with VBAC; (B) Dystocia or failure to progress as the indication for previous CS associated with VBAC success - odds ratio; (C) No association between fetal distress as the indication for previous CS and VBAC- odds ratio; (D) Fetal malpresentation as the indication for previous CS associated with VBAC success - odds ratio; (E) Dystocia or failure to progress as the indication for previous CS associated with VBAC success - adjusted odds ratio. (PNG 692 kb)
Race associated with VBAC success. (A) White Race associated with VBAC success - odds ratio; (B) Non-White race associated with VBAC success - odds ratio;(C) Non-white Race associated with VBAC success - adjusted odds ratio. (JPG 164 kb)
Association between age and VBAC. (A) Standardized mean differences; (B) Odds ratio; (C) Adjusted odds ratio. (JPG 169 kb)
Hypertensive disorder complicating pregnancy associated with VBAC success - Adjusted odds ratio. (JPG 103 kb)
Labor induction associated with VBAC success. (A) Odds ratio; (B) Adjusted odds ratio. (JPG 121 kb)
No association between smoke and VBAC. (JPG 95 kb)
No association between interdelivery interval and VBAC. (A) Standardized mean differences; (B) Odds ratio; (C) Adjusted odds ratio. (JPG 105 kb)
No association between gestational week and VBAC. (A) Standardized mean differences; (B) Odds ratio; (C) Adjusted odds ratio. (JPG 164 kb)
No association between epidural anesthesia and VBAC. (JPG 112 kb)
Characteristics of Meta analysis (DOCX 22 kb)
Characteristics of studies considered for this review. (DOCX 77 kb)
Newcastle-Ottawa quality assessment (DOCX 62 kb)
Subgroup analysis of factors (DOCX 73 kb)
. MOOSE Checklist (DOC 106 kb)
PRISMA checklist (DOC 118 kb)
Search strategy. (DOCX 26 kb)
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Wu, Y., Kataria, Y., Wang, Z. et al. Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis. BMC Pregnancy Childbirth 19, 360 (2019). https://doi.org/10.1186/s12884-019-2517-y
- Vaginal birth after cesarean section
- Trial of labor