Caesarean section and subsequent ectopic pregnancy: a systematic review and meta‐analysis. Issue 6 (11th February 2013)

• Record Type: Journal Article
• Authors: O'Neill, SM; Khashan, AS; Kenny, LC; Greene, RA; Henriksen, TB; Lutomski, JE; Kearney, PM
• Is Part Of: BJOG. Volume 120:Issue 6(2013:Jun.)
• Page Start: 671
• Page End: 680
• Publication Date: 2013-02-11
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12165
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12165-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12165-sec-0001" sec-type="section"> <title>Background</title> <p>Caesarean section rates are increasing worldwide, and the long‐term effects are unknown.</p> </sec> <sec id="bjo12165-sec-0002" sec-type="section"> <title>Objective</title> <p>To evaluate the risk of subsequent ectopic pregnancy in women with a previous caesarean section, compared with vaginal delivery.</p> </sec> <sec id="bjo12165-sec-0003" sec-type="section"> <title>Search strategy</title> <p>Systematic review of the literature using CINAHL, the Cochrane Library, Embase, Medline, PubMed, SCOPUS and Web of Knowledge, published from 1945 until 17 July 2011.</p> </sec> <sec id="bjo12165-sec-0004" sec-type="section"> <title>Selection criteria</title> <p>Cohort and case–control designs reporting on the mode of delivery and subsequent ectopic pregnancy. Two reviewers independently assessed the titles, abstracts, and full articles to identify eligible studies, using a standardised data collection form, and also assessed the study quality. Reference lists of the studies included were also cross‐checked.</p> </sec> <sec id="bjo12165-sec-0005" sec-type="section"> <title>Data collection and analysis</title> <p>Odds ratios (ORs) were combined using a random‐effect model to estimate the overall association between caesarean section delivery and the risk of subsequent ectopic pregnancy.</p> </sec> <sec id="bjo12165-sec-0006" sec-type="section"> <title>Main results</title> <p>Thirteen studies were included, which recruited a total of 61 978 women. Five studies reported adjustment for confounding factors, and the pooled OR of subsequent ectopic pregnancy following a caesarean section was 1.05 (95% CI 0.51–2.15). The removal of one study that reported outlier results yielded a pooled OR of 0.82 (95% CI 0.42–1.61). The pooled crude OR for all 13 studies was 1.36 (95% CI 0.99–1.88).</p> </sec> <sec id="bjo12165-sec-0007" sec-type="section"> <title>Author's conclusions</title> <p>This review found no evidence of an association between prior caesarean section delivery and the occurrence of a subsequent ectopic pregnancy, but the studies included were of poor or variable quality, and only a small number adjusted for potential confounding factors. Further research of a higher methodological quality is required to assess any potential association between mode of delivery and subsequent ectopic pregnancy.</p> </sec> </abstract>