Keag OE, et al. - This trial was pursued in order to illustrate the long-term risks and benefits of cesarean delivery for the mother, baby and subsequent pregnancies. Data exhibited a link between cesarean delivery with a reduced rate of urinary incontinence and pelvic organ prolapse when compared with vaginal delivery. However, this finding ought to be weighed against the correlation with increased risks for fertility, future pregnancy and long-term childhood outcomes. The yielded data could prove to be of value for counselling women regarding the mode of delivery.

Methods

• Herein, the primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death.
• Data analysis was carried out of the Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.
• Published studies in human subjects (last search 25 May 2017) were investigated, supplemented by manual searches.
• Randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies were included for this research with greater than or equal to one-year follow-up.
• The outcomes of women delivering by cesarean delivery and by vaginal delivery were comparatively analyzed.
• Two assessors screened 30,327 abstracts.
• Using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies, grading of studies was performed for the risk of bias by two assessors.
• Data accumulation was conducted in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I² ≥ 40%).

Results

• Researchers included 1 RCT and 79 cohort studies (all from high income countries) comprising of 29,928,274 candidates.
• Compared to vaginal delivery, a correlation was determined between cesarean delivery with a decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies).
• An increased risk of asthma was found among children delivered by cesarean delivery up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies).
• A connection was revealed between pregnancy after cesarean delivery with increased risk of miscarriage (OR 1.17, 1.03 to 1.32; n = 151,412; 4 studies) and stillbirth (OR 1.27, 1.15 to 1.40; n = 703,562; 8 studies).
• However, this was not noted with perinatal mortality (OR 1.11, 0.89 to 1.39; n = 91,429; 2 studies).
• Pregnancy following cesarean delivery exhibited a correlation with an increased risk of placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies), placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and placental abruption (OR 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies).