Main Findings
This systematic review summarised rates and outcomes associated with delivery after a prior CS in SSA. Overall, we found relatively high rates of TOLAC across the sub-region, with a median rate of 80%. Rates of VBAC were more variable median rates of 34-48% depending on study criteria. Maternal and perinatal outcomes were reported infrequently and with inconsistent definitions. Among those studies reporting outcomes, we found a uterine rupture rate of approximately 1%, maternal mortality ratio of 200 per 100,000 live births and perinatal mortality rate of 5 per 1000 births. There was no significant difference between TOLAC and ERCSfor rates of uterine rupture or maternal mortality. However perinatal mortality was significantly higher in the TOLAC group compared to the ERCS group. We found lower TOLAC and VBAC rates in studies after 1996 compared to those in 1996 or earlier; however, this did not reach statistical significance. . We also found sub-regional variation in the number of studies of TOLAC with relatively few in Central and East Africa and higher reported rates of adverse outcomes in Central and East Africa compared to South and West Africa.