Vaginal birth after two caesarean sections (VBAC-۲), success rate and adverse outcomes of VBAC-۲ versus VBAC-۱ and repeat caesarean sections: systematic review and meta-analysis

Background: Vaginal birth after Caesarean (VBAC) is often offered as an option after a single caesarean section (CS). Objectives: to evaluate the success rate of vaginal birth after two caesarean sections (VBAC-۲).Search strategy: Systematic review and meta-analysisSelection criteria and Data collection: We searched MEDLINE, EMBASE, PubMed, Scopus, using search terms (cesarean OR cesarean OR caesarean OR caesarian) AND (“Vaginal birth after” OR VBAC) AND (two OR Twice OR second OR multiple Two independent reviewers performed the study selection, and abstracted and tabulated data and pooled estimates were obtained. Meta-analyses were performed using Open-meta and Comprehensive Meta-Analysis.Main results: Mean success rate of VBAC-۲ was ۷۲% (۲۱۷۴ out of ۳۰۲۰ cases) with a range of ۲۴-۹۰%. Mean hysterectomy rate was ۰.۴۳% ranging from ۰% to ۱.۷%. Our meta-analysis showed no significant difference between VBAC-۲ and CS-۳ in the case of hysterectomy, with a pooled odds ratio (OR) of ۰.۶۹۹, but with a wide confidence interval (۹۵% CI was ۰.۳۴۷-۱.۴۰۷). VBAC-۲ being associated with ۲ fold increased risk of perinatal mortality compared to CS-۳. Conclusion: Vaginal delivery is a suitable option for women with two previous cesarean sections, the outcomes are significantly more favorable for women with history of vaginal birth.