Background Caesarean section rates have increased significantly in the past three decades, with one in four babies in the United Kingdom (UK) delivered operatively. In light of this, the National Institute for Health and Clinical Excellence (NICE) updated their caesarean section guidelines to give women the right to request a caesarean section without any medical indication. With the long term consequences of caesarean section on fertility unknown, further research is warranted.
Objective To compare pregnancy interval between women with a previous caesarean to women with a previous vaginal delivery.
Methods Study Design: Systematic review of the published literature. CINAHL, Cochrane library, Embase, Medline, PubMed, SCOPUS and Web of Knowledge databases were searched (1945-October 2012), using a detailed search-strategy and cross-checking of references. Cohort, case-control and cross-sectional studies were eligible. Two assessors individually reviewed titles, abstracts and full articles to identify eligible studies, using a standardised data-abstraction form and assessed study quality. A meta-analysis was not suitable due to between-study heterogeneity.
Results Data synthesis: Over 9,184 titles were screened, with 12 articles included. Four studies reported an increased waiting time to next pregnancy following a previous caesarean section delivery. However, variations in the definition of time to next pregnancy or birth used, as well as lack of adjustment for confounders, small sample size, inability to identify the indication for caesarean section, short follow-up time and lack of stratification by number of previous pregnancies were all obvious limitations. Eight studies reported no association between a previous caesarean section delivery and subsequent pregnancy interval. These were methodologically more superior with larger sample sizes, population-based registries, and detailed obstetrical information including indication for mode of delivery and long follow-up periods
Discussion Evidence on the relationship between caesarean delivery and pregnancy interval is conflicting. Residual confounding is possible and further research of better methodological quality is required to assess whether any delay in pregnancy interval is causal or as a result of parental choice to delay childbirth.
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