Abstract: Objective：The aim of this study was to compare the trial of labor with elective repeat cesarean delivery (ERCD) among women with previous cesarean delivery. Methods：We searched CENTRAL, Medline, Embase, Ovid, Wanfang, CNKI databases about the safety of maternal and perinatal of trial of labor after previous cesarean delivery (TOLAC) versus ERCD from 1989 through 2016. Results：Eleven studies with a total of 91 975 women were included. 51 428 women undergoing TOLAC, 40 547 women undergoing ERCD. Uterine rupture occurred more frequently among women undergoing TOLAC than among those undergoing ERCD (RR=2.78, 95%CI: 1.24~6.22, P=0.01). Mothers undergoing TOLAC were less likely to have hysterectomy (RR=0.57，95%CI: 0.44~0.74，P＜0.000 1). There were no differences in maternal puerperal infection (RR=1.10, 95%CI: 0.78~1.56, P=0.58), require transfusion(RR=1.09, 95%CI: 0.62~1.92, P=0.75) and maternal mortality (RR=0.71, 95%CI: 0.26~1.92，P=0.50） risk between the 2 groups. Asphyxia of newborn (RR=2.30，95%CI: 1.74~3.03，P＜0.000 01) and fetal or neonatal death  (RR=1.71，95%CI: 1.29~2.25，P=0.000 1) were more frequent in the TOLAC group than the control group. Conclusions：In order to reduce the rate of cesarean section, we should encourage TOLAC. Its security is very important, which required adequate prenatal assessment, strict and standardized monitoring of the delivery process for the maximum guarantee of maternal and child safety, but also a reasonable and scientific assessment of each cesarean section indications is necessary.

Key words: Vaginal birth after cesarean, Natural childbirth, Cesarean section, Postoperative period, Uterus；Cicatrix, Uterine rupture, Meta-analysis