European journal of obstetrics, gynecology, and reproductive biology · 2026
Spontaneous preterm birth risk after caesarean section at full dilatation in the first birth compared to all other births: A systematic review and meta-analysis of observational studies.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Cameron Natalie, Pirie Danielle, Black Mairead, Woolner Andrea
Аннотация
BACKGROUND: Caesarean section performed at full dilation (CSfd) has been associated with higher risk of spontaneous preterm birth (sPTB) in subsequent pregnancies. This review aimed to investigate the impact of a CSfd on subsequent pregnancies compared to all other modes of birth..
OBJECTIVES: To compare the risk of sPTB in a subsequent pregnancy following CSfd versus any other mode of birth in the index pregnancy.
SEARCH STRATEGY: MEDLINE, EMBASE, PubMed, Cochrane Library and Google Scholar were searched electronically following PRISMA guidance.
SELECTION CRITERIA: Eligible observational studies included women with at least two consecutive singleton births, where the first birth was at term (≥37 weeks). The exposure was CSfd versus any other birth mode in the index pregnancy, and the outcome was sPTB in the subsequent pregnancy.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed quality using the Newcastle-Ottawa Scale. Meta-analyses were performed using random effects models to synthesise pooled odds ratios (OR) for sPTB using RevMan software.
MAIN RESULTS: Fourteen studies were included, pooling data from 708,102 women (1998-2022). Compared against any other mode of birth, CSfd was associated with a significantly increased risk of sPTB (OR 1.91 [95% confidence interval (CI) 1.79, 2.04]). Subgroup analyses showed doubled the odds of sPTB < 34 weeks gestation after CSfd (OR 2.90 [95% CI: 2.49, 3.38]). Risk of bias was low in the majority of included studies.
CONCLUSIONS: We have demonstrated a clear relationship between CSfd and subsequent sPTB. This information may help to inform surveillance pathways, such as cervical length screening in future pregnancies.
OBJECTIVES: To compare the risk of sPTB in a subsequent pregnancy following CSfd versus any other mode of birth in the index pregnancy.
SEARCH STRATEGY: MEDLINE, EMBASE, PubMed, Cochrane Library and Google Scholar were searched electronically following PRISMA guidance.
SELECTION CRITERIA: Eligible observational studies included women with at least two consecutive singleton births, where the first birth was at term (≥37 weeks). The exposure was CSfd versus any other birth mode in the index pregnancy, and the outcome was sPTB in the subsequent pregnancy.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed quality using the Newcastle-Ottawa Scale. Meta-analyses were performed using random effects models to synthesise pooled odds ratios (OR) for sPTB using RevMan software.
MAIN RESULTS: Fourteen studies were included, pooling data from 708,102 women (1998-2022). Compared against any other mode of birth, CSfd was associated with a significantly increased risk of sPTB (OR 1.91 [95% confidence interval (CI) 1.79, 2.04]). Subgroup analyses showed doubled the odds of sPTB < 34 weeks gestation after CSfd (OR 2.90 [95% CI: 2.49, 3.38]). Risk of bias was low in the majority of included studies.
CONCLUSIONS: We have demonstrated a clear relationship between CSfd and subsequent sPTB. This information may help to inform surveillance pathways, such as cervical length screening in future pregnancies.