SynthesisPloS one2013
Caesarean delivery and subsequent stillbirth or miscarriage: systematic review and meta-analysis.
Synthesis in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 4 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis.PLoS medicine · 2018Pooled it
- Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies.Public health nutrition · 2016Pooled it
- Caesarean Section--A Density-Equalizing Mapping Study to Depict Its Global Research Architecture.International journal of environmental research and public health · 2015Pooled it
- Support for mothers, fathers and families after perinatal death.The Cochrane database of systematic reviews · 2013Pooled it
- Stillbirth burden and associated factors in Chengdu, Western China: a population-based retrospective study, 2019-2024.BMC pregnancy and childbirth · 2025Article
- Prevalence and associated factors of stillbirth among women at extreme ages of reproductive life in Sub-Saharan Africa: a multilevel analysis of the recent demographic and health survey.Maternal health, neonatology and perinatology · 2025Article
- Cesarean section at full dilatation in the first birth is not associated with an increased risk of subsequent miscarriage: A historical cohort study.Acta obstetricia et gynecologica Scandinavica · 2024Article
- Development of a multivariate predictive nomogram among women with antepartum fetal death diagnosed at ≥ 34 weeks of gestation for outcome of TOLAC.Archives of gynecology and obstetrics · 2024Observational
- Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study.Archives of gynecology and obstetrics · 2024Article
- Maternal health outcomes in the context of fragility: a retrospective study from Lebanon.Conflict and health · 2023Article
- Prevalence and determinants of caesarean section deliveries in the Kintampo Districts of Ghana.BMC pregnancy and childbirth · 2023Article
- Outcome of subsequent pregnancies in women with complete uterine rupture: A population-based case-control study.Acta obstetricia et gynecologica Scandinavica · 2022Article
- Birth defects in Brazil: Outcomes of a population-based study.Genetics and molecular biology · 2020Article
- Effect of a two-stage intervention package on the cesarean section rate in Guangzhou, China: A before-and-after study.PLoS medicine · 2019Article
- Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study.BMJ (Clinical research ed.) · 2019Article
- Risk of stillbirth among Zambian women with a prior cesarean delivery.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2018Article
- Obstetrical outcomes after vaginal repair of caesarean scar diverticula in reproductive-aged women.BMC pregnancy and childbirth · 2018Article
- Outcome of caesarean section at the Edward Francis Small Teaching Hospital, Banjul The Gambia.African health sciences · 2018Article
- Care quality following intrauterine death in Spanish hospitals: results from an online survey.BMC pregnancy and childbirth · 2018Article
- MRI findings of complications related to previous uterine scars.European journal of radiology open · 2018Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery.
designSystematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11(th) 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.
conclusionsGiven 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.