Abstract
Background: The increasing rates of Caesarean section (CS) beyond the WHO standards (10–15%) pose a significant global health concern.Objective: Systematic review and meta-analysis to identify an association between CS history and maternal adverse outcomes for the subsequent pregnancy and delivery among women classified in Robson classification (RC).Search Strategy: PubMed/Medline, EbscoHost, ProQuest, Embase, Web of Science, BIOSIS, MEDLINE, and Russian Science Citation Index databases were searched from 2008 to 2018.Selection Criteria: Based on Robson classification, studies reporting one or more of the 14 adverse maternal outcomes were considered eligible for this review.Data Collection: Study design data, interventions used, CS history, and adverse maternal outcomes were extracted.Main Results: From 4,084 studies, 28 (n = 1,524,695 women) met the inclusion criteria. RC group 5 showed the highest proportion among deliveries followed by RC10, RC7, and RC8 (67.71, 32.27, 0.02, and 0.001%). Among adverse maternal outcomes, hysterectomy had the highest association after preterm delivery OR = 3.39 (95% CI 1.56–7.36), followed by Severe Maternal Outcomes OR = 2.95 (95% CI 1.00–8.67). We identified over one and a half million pregnant women, of whom the majority were found to belong to RC group 5.Conclusions: Previous CS was observed to be associated with adverse maternal outcomes for the subsequent pregnancies. CS rates need to be monitored given the prospective risks which may occur for maternal and child health in subsequent births.
Highlights
High rates of maternal mortality due to the common preventable causes like haemorrhage, eclampsia, and sepsis (1) call for safe procedures like Caesarean Section (CS)
Studies reporting previous caesarean section (CS) for all participants, adverse maternal events as the outcome variable, and those providing sufficient statistical data were included in this research. Those researches were included, which were conducted on participants who had had at least one prior CS and could be classified as Robson 5,7,8,9, or 10 according to Robson classification described by the WHO (9)
This result is in accordance with a previous study that showed elective repeated caesarean delivery might be associated with a higher risk of hysterectomy and neonatal respiratory problems (38)
Summary
High rates of maternal mortality due to the common preventable causes like haemorrhage, eclampsia, and sepsis (1) call for safe procedures like Caesarean Section (CS). In addition to increased risk of neonatal and perinatal mortality in vaginal birth after caesarean (VBAC) (3), previous CS has been reported as being associated with adverse outcomes of subsequent pregnancies such as maternal mortality, blood transfusion, admission in critical care, and hysterectomy (4–6). There has been no previous study with a systematic review design followed by a meta-analysis that discusses the history of caesarean section (repeated) with maternal and perinatal adverse outcomes by grouping the women based on the WHO classification. Previous studies have reported a relationship between the history of caesarean section and individual adverse maternal outcomes rather than pooled evidence on several maternal outcomes. The current review and meta-analysis aim at assessing women according to Robson’s classification and to report pooled evidence on the impacts of previous CS on outcomes of the subsequent pregnancy. The increasing rates of Caesarean section (CS) beyond the WHO standards (10–15%) pose a significant global health concern
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