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

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dc.contributor.authorO'Neill, Sinéad M.
dc.contributor.authorKearney, Patricia M.
dc.contributor.authorKenny, Louise C.
dc.contributor.authorKhashan, Ali S.
dc.contributor.authorHenriksen, Tine B.
dc.contributor.authorLutomski, Jennifer E.
dc.contributor.authorGreene, Richard A.
dc.date.accessioned2016-02-25T12:04:14Z
dc.date.available2016-02-25T12:04:14Z
dc.date.issued2013
dc.description.abstractObjective: 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.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide54588
dc.identifier.citationO’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.0054588en
dc.identifier.doi10.1371/journal.pone.0054588
dc.identifier.issn1932-6203
dc.identifier.issued1en
dc.identifier.journaltitlePLOS ONEen
dc.identifier.urihttps://hdl.handle.net/10468/2396
dc.identifier.volume8en
dc.language.isoenen
dc.publisherPublic Library of Scienceen
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 crediteden
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectHigh income countriesen
dc.subjectRisk factorsen
dc.subjectPerinatal deathen
dc.subjectMaternal ageen
dc.subjectAntepartum stillbirthen
dc.subjectPregnancy lossen
dc.subjectUnexplained stillbirthen
dc.subjectRetrospective cohorten
dc.subjectObstetric factorsen
dc.subjectSmoking habitsen
dc.titleCaesarean delivery and subsequent stillbirth or miscarriage: systematic review and meta-analysisen
dc.typeArticle (peer-reviewed)en
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