Parto vaginal bem sucedido após duas ou mais cesáreas versus falha no ensaio de parto: revisão sistemática e metanálise de desfechos maternos e fetais

Resumo original em inglês

O que aconteceu

To assess maternal and neonatal outcomes associated with a failed versus successful (VBAC-2). A systematic search across Pubmed, Embase and Cochrane was conducted up to October 2025, supplemented by backward snowballing. Studies with pregnant women with a two or more previous cesarean deliveries undergoing a trial of labor were included. No restrictions were applied. Data on maternal and neonatal outcomes and risk and protective factors were extracted. The DerSimonian and Laird random effects model was applied, reporting Odds Ratios (OR) with 95% confidence intervals. Heterogeneity was evaluated using I2 statistics and the Cochran Q test. Methodological quality was appraised using the Cochrane Risk-of-bias tool for non-randomized trials (ROBINS-I). Out of 4065 studies screened, 12 studies (n= 3429) were included. We observed higher odds of postpartum hemorrhage (OR 1.98), maternal transfusion (OR 3.29), uterine rupture (OR 6.47), and neonatal intensive care unit admission (OR 6.44) in the VBAC-2 failure group. Epidural anesthesia (OR 0.56) and a history of previous vaginal birth (OR 0.27) were identified as protective factors, while a higher Body Mass Index was a risk factor for VBAC- 2 failure. These findings highlight the critical need for comprehensive patient counseling, risk assessment, and heightened clinical vigilance to optimize care strategies in this high-risk population.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.