Maternal and neonatal complications of trial of labor after two cesarean sections (TOLAC-2) compared with repeat cesarean section (RCS-2): Systematic review and meta-analysis

Title: Maternal and neonatal complications of the trial of labour after two caesarean sections (PPDC-2) versus repeat caesarean section (CR-2): Systematic review and meta-analysis. Background: PPDC-2 is a behavior that is not accepted in all latitudes. Women who want natural childbirth do not receive the opportunity. The objective wasto conduct a systematic review and meta-analysis on the maternal and neonatal complications of PPDC-2 versus CR-2. Methods: The eligibility criteria were: pregnant women of ≥22 weeks, two cesarean sections, cephalic presentation, no contraindications to natural delivery, no fetal malformations who undergo PPDC-2. We searched the libraries PubMed, Scopus, Embase and other websites of organisations linked to Obstetrics and Gynaecology. We assessed risk of bias using the Newcastle-Ottawa Scale. The Synthetic Method was used to summarize and present the results. Results: The number of included articles that met the eligibility criteria was 10, with 3316 participants in the intervention group (PPDC-2) and 54054 in the control group (CR-2). The studies were cohort studies. The average success rate of PPDC-2 was 62.1%. There were no differences in maternal and neonatal complications in most publications. The rate of uterine rupture was very small. Discussion: The information comes from good quality cohort studies (level of evidence 2b). PPDC-2 is a reasonable and relatively safe option, comparable to CR-2. Others: It was financed with own resources, no protocol was carried out and it was not recorded on the basis of systematic reviews.