Maternal morbidity following a trial of labor after cesarean birth: A scoping review of operative vaginal birth compared with cesarean birth in the second stage of labor
Bibliographic record
Abstract
BACKGROUND: Increased use of operative vaginal birth (OVB; forceps and vacuum) has been proposed as a strategy to avoid cesarean birth (CB) among individuals who elect a trial of labour after CB (TOLAC). The relative maternal safety of OVB and CB in individuals with a TOLAC is poorly understood. OBJECTIVE: To summarize the available evidence and methodologic quality of the literature on the use of OVB versus CB in the second stage of labor with a focus on maternal morbidity in individuals with a TOLAC. SEARCH STRATEGY: We searched OVID MEDLINE, EMBASE, and Web of Science after 1950 to August 8, 2023. SELECTION CRITERIA: Experimental and observational studies of individuals with a TOLAC having had OVB compared with CB in the second stage of labor. DATA COLLECTION AND ANALYSIS: Relevant characteristics (participant information, OVB and CB distribution, and comparative estimates of maternal morbidity) were abstracted. Findings were summarized narratively, with results presented in tabular form to highlight key comparisons. MAIN RESULTS: Five cohort studies conducted in the USA, Israel, or Australia were included. Higher rates of surgical injuries (9/87, 10.3% vs. 19/788, 2.4%), cystotomy (12/486, 2.5% vs. 4/743, 0.5%), and ureter injury (1/486, 0.2% vs. 1/743, 0.1%) were reported with second-stage CB compared with OVB. Rates of composite maternal morbidity were elevated with OVB, but higher rates of endometritis and wound complications were documented with second-stage CB compared with OVB. All studies were at high risk of bias. CONCLUSIONS: Optimal management of individuals requiring operative birth following a TOLAC remains unclear.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.091 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.012 | 0.015 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".