Correlation Between Previous Caesarean Section and Adverse Maternal Outcomes Accordingly With Robson Classification: Systematic Review and Meta-Analysis

Shazia Jamshed; Shuo-Chen Chien; Afifa Tanweer; Rahma-Novita Asdary; Muhammad Hardhantyo; David Greenfield; Chia-Hui Chien; Shuen-Fu Weng; Wen-Shan Jian; Usman Iqbal

doi:10.3389/fmed.2021.740000

Correlation Between Previous Caesarean Section and Adverse Maternal Outcomes Accordingly With Robson Classification: Systematic Review and Meta-Analysis

Front Med (Lausanne). 2022 Jan 10:8:740000. doi: 10.3389/fmed.2021.740000. eCollection 2021.

Authors

Shazia Jamshed^{1

2}, Shuo-Chen Chien^{3

4}, Afifa Tanweer⁵, Rahma-Novita Asdary⁶, Muhammad Hardhantyo^{7

8

9}, David Greenfield^{10

11}, Chia-Hui Chien^{3

4

12}, Shuen-Fu Weng^{13

14}, Wen-Shan Jian^{4

15}, Usman Iqbal^{4

6

16}

Affiliations

¹ Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Malaysia.
² Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia.
³ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
⁴ International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.
⁵ Department of Nutrition Sciences, School of Health Sciences, University of Management and Technology, Lahore, Pakistan.
⁶ Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.
⁷ Graduate Program of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
⁸ Faculty of Health Science, Universitas Respati Yogyakarta, Depok, Indonesia.
⁹ Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Depok, Indonesia.
¹⁰ The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales (UNSW) Medicine, Sydney, NSW, Australia.
¹¹ Linéaire Projects, Sydney, NSW, Australia.
¹² Office of Public Affairs, Taipei Medical University, Taipei, Taiwan.
¹³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
¹⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁵ School of Health Care Administration, School of Gerontology Health Management, Graduate Institute of Data Science, Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁶ Ph.D. Program in Depatment of Global Health & Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan.

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.

Keywords: World Health Organisation - Robson Classification; adverse maternal outcomes; global health; previous caesarean section; public health practice; women's health.

Publication types

Systematic Review