Vaginal birth after previous two or more caesarean sections: a systematic review

Vaginal birth after caesarean section (VBAC) is an appropriate solution to decrease the caesarean section rates and also to minimise the morbidities and complications due to repeat caesarean sections. Though trial for vaginal birth, that too after two or more caesarean sections is challenging, it will certainly help in reducing caesarean rates worldwide if tackled by proper decision making and vigilant observation. Present study is intended to review the research publications surrounding VBAC-2. Search was carried out for gathering research publications up to April 2024 by using the keywords of "Vaginal birth after two or more caesarean sections", "trial of labour after two or more caesarean section", "VBAC-2", or "TOLAC-2". 51 relevant publications were considered in present study. Success rates of VBAC-2 studies were calculated as 70.83% for the study population. Furthermore, uterine rupture, blood transfusion, hysterectomy, maternal and neonatal outcomes were analysed after VBAC-2. Besides these, 14 case studies were analysed separately. Results indicate that VBAC-2 is safe, but careful patient selection and vigilant monitoring of indications is necessary for decision making. Information gathered and analysed will help in making evidence centred decisions in such cases.