Methods

Randomised trial conducted in 14 maternity units in Australia between November 2002 and May 2007.

Participants

Women were eligible with a single prior caesarean section, live singleton fetus at 37 weeks' gestational age, and who were considered eligible to attempt VBAC by caregiver.

Women with any of the following were excluded: more than 1 prior caesarean; vertical/inverted T/unknown uterine incision; prior uterine rupture; prior uterine surgery involving entry of uterine cavity; prior uterine perforation; multiple pregnancy; any contraindication to vaginal birth (placenta praevia; transverse lie; active genital herpes); cephalopelvic disproportion; lethal congenital anomaly; fetal anomaly associated with mechanical difficulties at birth.

Interventions

22 eligible women were randomised to either planned vaginal birth or to planned caesarean section.

Where women planned vaginal birth, the spontaneous onset of labour was awaited. Where women planned an elective caesarean section, this was scheduled between 38 and 40 weeks' gestation.

Outcomes

The primary outcome was a composite of death or serious adverse outcome for infant. A range of secondary clinical outcomes reflecting serious adverse outcomes for the woman and infant were reported.

Notes

This study was conducted as a randomised trial nested within a larger prospective patient preference study. The inclusion and exclusion criteria and reported outcomes were the same for both the randomised and patient preference components of the study.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random number sequence.

Allocation concealment (selection bias)

Low risk

Telephone randomisation service.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No losses to follow‐up reported.

Selective reporting (reporting bias)

Low risk

Outcomes identified in the published protocol have been reported.

Other bias

Low risk

No other bias identified.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

No blinding of participants, caregivers or outcome assessors but not considered likely to bias outcomes.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

No blinding of participants, caregivers or outcome assessors but not considered likely to bias outcomes.

Methods

Randomised trial conducted in a single maternity unit affiliated with University of Hong Kong, Hong Kong. 

Participants

Women were eligible with a single prior caesarean section, who were considered eligible to attempt vaginal birth by their caregiver.

Women with a prior vaginal birth or any contraindication to attempting vaginal birth were excluded.

Interventions

298 eligible women were randomised to either planned vaginal birth or to planned caesarean section prior to 28 weeks' gestation.

Where women planned vaginal birth, the spontaneous onset of labour was awaited. Where women planned an elective caesarean section, this was scheduled at 38 weeks' gestation.

Outcomes

The primary outcomes were maternal psychometric assessments (EPDS, Beck Depression Inventory; State‐Trait Anxiety Inventory; General Health Questionnaire (GHQ‐12); Client Satisfaction Questionnaire) measured at 6 months postpartum.

Notes

There are no maternal or infant clinical outcomes reported.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random number sequence.

Allocation concealment (selection bias)

Low risk

Sealed, opaque, sequentially numbered envelopes.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

6 women refused to participate after randomisation; 1 woman was excluded after randomisation due to ineligibility.

Selective reporting (reporting bias)

Low risk

Specified primary outcomes are reported; there are no clinical maternal or infant outcomes reported.

Other bias

Low risk

No other bias identified.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

No blinding of participants, caregivers or outcome assessors but not considered likely to bias outcomes.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

No blinding of participants, caregivers or outcome assessors but not considered likely to bias outcomes.