Abstract
Background Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean. Vaginal birth after cesarean carries a greater risk of uterine rupture, defined as the disruption of all uterine layers, resulting in maternal-fetal morbidity or mortality. It is unclear how the risk of uterine rupture compares in patients with twin gestations who undergo different delivery methods. Objective The purpose of this systematic review is to determine if there is an increased risk of uterine rupture in patients with twin gestations attempting vaginal birth after cesarean (VBAC) versus planned repeat cesarean delivery (PRCD). Study Design. PubMed, Cochrane Library, and CINAHL were searched systematically. Eligible studies were prospective and retrospective studies that evaluated the incidence of uterine rupture in twin pregnancies that attempted VBAC or PRCD. Data were manually extracted from these studies, and the number of events in each group was used to calculate an odds ratio (OR) and 95% confidence interval (CI). Results 4 retrospective studies were included with a total of 7699 participants, 2305 of whom attempted VBAC and 5394 underwent PRCD. The absolute risk of uterine rupture in the VBAC and PRCD groups was 0.87% and 0.09%, respectively. The rate of uterine rupture was significantly higher in the VBAC group than in the PRCD group (OR: 9.43; CI: 3.54–25.17). Conclusion Although VBAC is associated with higher rates of uterine rupture in twin pregnancies when compared with PRCD, the absolute risk of uterine rupture is low in both groups. Depending on individual risk factors, vaginal birth may be offered as a safe option to women with twin pregnancies and a history of cesarean delivery.
Highlights
Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean
A total of 712 records were screened and 19 full-text articles were evaluated. 15 studies were eliminated based on exclusion criteria. 4 studies were considered potentially eligible, and none of them were determined to be of poor quality (Figure 1)
Systematic review of published studies revealed that the risk of uterine rupture is significantly higher in women with twin gestations who attempt vaginal birth after cesarean (VBAC) as opposed to planned repeat cesarean delivery (PRCD)
Summary
Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean. E purpose of this systematic review is to determine if there is an increased risk of uterine rupture in patients with twin gestations attempting vaginal birth after cesarean (VBAC) versus planned repeat cesarean delivery (PRCD). Various studies have shown null and positive associations between VBAC attempts in twin pregnancies and the risk of uterine rupture as compared to PRCD [27,28,29,30,31,32,33,34] Due to this controversy in the literature, there is a need for a systematic review. Search terms were related to the population of interest (women with twin pregnancies and a previous cesarean), intervention (VBAC attempt), comparator (PRCD), and outcome (uterine rupture). A study was included if it was prospective or retrospective, considered women with twin pregnancies and a previous cesarean, compared VBAC attempt and PRCD, and assessed for uterine rupture. Since the outcome was not present in every group, the sum of the events across the studies was used to calculate an odds ratio (OR) and 95% confidence interval (CI)
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