Caesarean delivery and subsequent stillbirth or miscarriage: systematic review and meta-analysis

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dc.contributor.author O'Neill, Sinéad M.
dc.contributor.author Kearney, Patricia M.
dc.contributor.author Kenny, Louise C.
dc.contributor.author Khashan, Ali S.
dc.contributor.author Henriksen, Tine B.
dc.contributor.author Lutomski, Jennifer E.
dc.contributor.author Greene, Richard A.
dc.date.accessioned 2016-02-25T12:04:14Z
dc.date.available 2016-02-25T12:04:14Z
dc.date.issued 2013
dc.identifier.citation O’Neill SM, Kearney PM, Kenny LC, Khashan AS, Henriksen TB, Lutomski JE, et al. (2013) Caesarean Delivery and Subsequent Stillbirth or Miscarriage: Systematic Review and Meta-Analysis. PLoS ONE 8(1): e54588. doi:10.1371/journal.pone.0054588 en
dc.identifier.volume 8 en
dc.identifier.issued 1 en
dc.identifier.issn 1932-6203
dc.identifier.uri http://hdl.handle.net/10468/2396
dc.identifier.doi 10.1371/journal.pone.0054588
dc.description.abstract Objective: To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous Caesarean or vaginal delivery. Design: Systematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11th 2011, using a detailed search-strategy and cross-checking of reference lists. Study Selection: Cohort, case-control and cross-sectional studies examining the association between previous Caesarean section and subsequent stillbirth or miscarriage risk. Two assessors screened titles to identify eligible studies, using a standardised data abstraction form and assessed study quality. Data synthesis: 11 articles were included for stillbirth, totalling 1,961,829 pregnancies and 7,308 events. Eight eligible articles were included for miscarriage, totalling 147,017 pregnancies and 12,682 events. Pooled estimates across the stillbirth studies were obtained using random-effect models. Among women with a previous Caesarean an increase in odds of 1.23 [95% CI 1.08, 1.40] for stillbirth was yielded. Subgroup analyses including unexplained stillbirths yielded an OR of 1.47 [95% CI 1.20, 1.80], an OR of 2.11 [95% CI 1.16, 3.84] for explained stillbirths and an OR of 1.27 [95% CI 0.95, 1.70] for antepartum stillbirths. Only one study reported adjusted estimates in the miscarriage review, therefore results are presented individually. Conclusions: Given the recent revision of the National Institute for Health and Clinical Excellence guidelines (NICE), providing women the right to request a Caesarean, it is essential to establish whether mode of delivery has an association with subsequent risk of stillbirth or miscarriage. Overall, compared to vaginal delivery, the pooled estimates suggest that Caesarean delivery may increase the risk of stillbirth by 23%. Results for the miscarriage review were inconsistent and lack of adjustment for confounding was a major limitation. Higher methodological quality research is required to reliably assess the risk of miscarriage in subsequent pregnancies. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Public Library of Science en
dc.rights © 2013 O’Neill et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited en
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en
dc.subject High income countries en
dc.subject Risk factors en
dc.subject Perinatal death en
dc.subject Maternal age en
dc.subject Antepartum stillbirth en
dc.subject Pregnancy loss en
dc.subject Unexplained stillbirth en
dc.subject Retrospective cohort en
dc.subject Obstetric factors en
dc.subject Smoking habits en
dc.title Caesarean delivery and subsequent stillbirth or miscarriage: systematic review and meta-analysis en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Sinéad M. O’ Neill, Epidemiology & Public Health, Western Gateway Building, Western Road, Cork, University College Cork, Cork, Ireland. +353-21-490-3000 Email: sinead.oneill@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.internal.rssid 198534276
dc.internal.rssid 279140942
dc.internal.wokid WOS:000314021500090
dc.description.status Peer reviewed en
dc.identifier.journaltitle PLOS ONE en
dc.internal.IRISemailaddress sinead.oneill@ucc.ie en
dc.identifier.articleid e54588


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© 2013 O’Neill et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Except where otherwise noted, this item's license is described as © 2013 O’Neill et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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