The review question was clear and was supported by appropriate inclusion criteria for participants, intervention and outcome, with broad criteria for study design. Five databases were searched, but the search was restricted to articles in English, which meant that language bias may have been introduced. There were no apparent attempts to search for unpublished data, so potentially relevant articles may have been missed. Study selection and data extraction were not performed in duplicate, so reviewer error and bias could not be ruled out.
Validity assessment was not undertaken, so the quality of the included studies was unknown. The methods used to pool the data were not reported and it was unclear whether the pooling of the studies was appropriate given the differences in study methods and the lack of data on patient characteristics. In addition, statistical heterogeneity did not appear to have been assessed. The author acknowledged that there were a limited number of women at risk and, given the even smaller number of uterine ruptures experienced, a precise estimate was not possible.
The authors' conclusions appeared to reflect the evidence but, given the limitations with the review process, the uncertain quality of the included studies and the general lack of detail reported in the review, the authors' conclusions should be interpreted with caution.