***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The data about the safety of vaginal birth  after caesarean section are conflicting . This study in a referral hospital in Sana'a , Yemen investigated the outcome of  vaginal birth  after caesarean section in 357 women who had one prior caesarean section and were admitted to hospital at term with spontaneous onset of labour . A  control group ( n = 155 ) was matched from women without previous caesarean section .  The success rate of  vaginal birth  after caesarean section was 311/357 ( 87.1 % ) . The mean duration of the first and second stages of labour were not significantly different in the study group ( 146.2 and 30.7 min respectively ) compared with the control group ( 146.7 and 29.8 min ) . There were infrequent complications ; only 1 woman ( 0.3 % ) had ruptured uterus and 3 women ( 1.0 % ) suffered uterine dehiscence . There was 1 stillbirth after the uterine rupture but no maternal deaths Objective To assess the risks and benefits associated with  caesarean delivery compared with vaginal delivery . Design Prospect i ve cohort study within the 2005 WHO global survey on maternal and perinatal health . Setting 410 health facilities in 24 areas in eight r and omly selected Latin American countries ; 123 were r and omly selected and 120 participated and provided data Participants 106 546 deliveries reported during the three month study period , with data available for 97 095 ( 91 % coverage ) . Main outcome measures Maternal , fetal , and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery , adjusted for clinical , demographic , pregnancy , and institutional characteristics . Results Women undergoing caesarean delivery  had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery ( odds ratio 2.0 ( 95 % confidence interval 1.6 to 2.5 ) for intrapartum caesarean and 2.3 ( 1.7 to 3.1 ) for elective caesarean ) . The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries . With cephalic presentation , there was a trend towards a reduced odds ratio for fetal death with elective caesarean , after adjustment for possible confounding variables and gestational age ( 0.7 , 0.4 to 1.0 ) . With breech presentation , caesarean delivery had a large protective effect for fetal death . With cephalic presentation , however , independent of possible confounding variables and gestational age , intrapartum and  elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care ( 2.1 ( 1.8 to 2.6 ) and 1.9 ( 1.6 to 2.3 ) , respectively ) and the risk of neonatal mortality up to hospital discharge ( 1.7 ( 1.3 to 2.2 ) and 1.9 ( 1.5 to 2.6 ) , respectively ) , which remained higher even after exclusion of all caesarean deliveries for fetal distress . Such increased risk was not seen for breech presentation . Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery , but rupturing of membranes may be protective . Conclusions Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations A r and omized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section . The guideline recommended clinical actions to increase trial of labor and vaginal birth rates . Charts for all 3552 cases in the study groups were audited . After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group , but rates were 46 % and 85 % higher , respectively , among physicians educated by an opinion leader . Duration of hospital stay was lower in the opinion leader education group than in the other two groups . The overall cesarean section rate was reduced only in the opinion leader education group . There were no adverse clinical outcomes attributable to the interventions . The use of opinion leaders improved the quality of care Objective To determine whether antepartum X‐ray pelvimetry ( XRP ) reliably identified women suitable for a trial labour or repeat elective caesarean section after one previous section In response to a Western Australian Ministerial enquiry into the levels of intervention in childbirth , a 2‐year prospect i ve audit was undertaken of the indication and timing of all public Caesarean section deliveries at King Edward Memorial hospital . During the study period , a total of 9,138 deliveries were performed at the hospital , of which 1,624 were by Caesarean section , an overall rate of 17.8 % . Of these , 633 ( 39 % ) were elective and 911 ( 61 % ) were nonelective . The most common primary indication for  elective Caesarean section  was maternal choice , largely due to a refusal of the patient to consent to a trial of scar following a single previous Caesarean section or a refusal to attempt a trial of vaginal breech delivery . The most common indications for  nonelective Caesarean section  birth were an intrapartum diagnosis of suspected fetal distress or failure to progress in labour . Strategies to reduce the incidence of Caesarean section birth need to focus on the pathways involved with maternal decision‐making in the birth process , and on improving the diagnosis of intrapartum fetal compromise 
    Output:
    
The use of external peer review , audit and feedback had no significant effect on VBAC rates .
An educational strategy delivered by an opinion leader significantly increased VBAC rates .
The use of XRP significantly increased CS rates .
An opinion leader educational strategy confers benefit for increasing VBAC rates .