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The systematic review included a total of 4 retrospective studies that were published in the United States between 1996 and 2006 [31–34]. One study obtained data from a single hospital, while 3 of the studies collected data from multiple hospitals [32–34]. The studies discovered 7699 women who had twin pregnancies and had previously undergone cesarean sections. Of these, 5394 underwent PRCD and 2305 attempted VBAC (Table 1).
In conclusion, although the absolute risk of uterine rupture is low, the relative risk is higher for VBAC attempts, making VBAC a viable and safe option for many twin mothers. Other risk factors that may influence the outcome of delivery, such as maternal and gestational age, must be taken into account using an individualized strategy. When choosing the safest delivery method for a patient, clinicians must also take into account and discuss maternal-fetal risks other than uterine rupture. Accordingly, depending on their additional risk factors, women with twin pregnancies and a history of cesarean delivery may be safely given the option of VBAC.
In the United States, the prevalence of cesarean deliveries has significantly increased, rising from 5 5% in 1970 to 31. 9% in 2016 . Similarly, the national rate of twin deliveries has increased 79% from 1980 to 2016 (from 18 9 to 33. 9 per 1,000) . Due to this, obstetricians are seeing more patients with twin pregnancies and a history of cesarean delivery. Multiple pregnancies (97%E2%80%9398% of which are twins) have a twofold risk of maternal death and more complications including eclampsia, postpartum hemorrhage, and preterm labor [3%E2%80%935] Maternal morbidity is twice as likely to occur in women who have had previous cesarean sections, and placental problems are more common in these women [6–10].
19 full-text articles out of 712 total records were evaluated. 15 studies were eliminated based on exclusion criteria. There were 4 studies that may have qualified, and none of them were found to be of poor quality (Figure 1).
Uterine rupture rates ranged from 0% to 1. 69% (Table 2). The largest study reported an elevated rate of uterine rupture with VBAC attempts, while the other three studies found no discernible difference in the rates of uterine rupture between the groups [31–33].