caesarean delivery and subsequent fetal death systematic review and meta analysis n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Caesarean delivery and subsequent fetal death Systematic review and meta-analysis PowerPoint Presentation
Download Presentation
Caesarean delivery and subsequent fetal death Systematic review and meta-analysis

Loading in 2 Seconds...

play fullscreen
1 / 23

Caesarean delivery and subsequent fetal death Systematic review and meta-analysis - PowerPoint PPT Presentation


  • 165 Views
  • Uploaded on

Caesarean delivery and subsequent fetal death Systematic review and meta-analysis. Sinéad O Neill PhD student. Caesarean Sections (% of Total Live Births) 2000-2009. Source: European Health For All Database, WHO Regional Office for Europe, Copenhagen, Denmark.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Caesarean delivery and subsequent fetal death Systematic review and meta-analysis' - denali


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
caesarean delivery and subsequent fetal death systematic review and meta analysis

Caesarean delivery and subsequent fetal death Systematic review and meta-analysis

Sinéad O Neill

PhD student

caesarean sections of total live births 2000 2009
Caesarean Sections (% of Total Live Births) 2000-2009

Source: European Health For All Database, WHO Regional Office for Europe, Copenhagen, Denmark

national institute for health clinical excellence nice revised guidelines
National Institute for Health & Clinical Excellence (NICE) revised guidelines
  • Updated November 2011
  • Evidence-based advice to women wishing to have a Caesarean delivery
  • NICE believe it will avoid “unnecessary” Caesareans, reduce the rates and dispel the myth “once a Caesarean, always a Caesarean”

Source: CG132 Caesarean section: NICE guidelines, Nov 2011

the media spin
The Media Spin…..

“Women can choose Caesarean birth….even when there is no medical need!” [BBC NEWS]

“Caesarean section on demand are madness” [Daily Mail]

“Too posh to push? More C-sections on demand” [The Guardian]

slide7
Aim
  • To estimate the pooled risk of stillbirth and miscarriage in the subsequent delivery in women who had a previous Caesarean delivery, with women who had a previous vaginal delivery
some figures
Some figures….
  • Stillbirth
    • In high-income countries, one in every 200 pregnant women reaching 22 weeks gestation will have a stillborn baby
  • Miscarriage
    • 20-25% of recognised pregnancies end in miscarriage
study design and data sources
Study design and data sources
  • Systematic review (PRISMA guidelines)
  • Databases searched

CINAHL, the Cochrane Library, Embase, Medline, PubMed, Scopus and Web of Knowledge

  • No date/language restrictions (1945-Nov 2011)
  • Comprehensive list of search terms, cross-checking of reference lists
methods
Methods
  • Inclusion criteria
    • Cohort, cross-sectional,case-control
  • Exclusion criteria

- RCTS, reviews, editorials, unpublished literature

  • Two reviewers; independent searches; standardised data collection form
  • Meta-analysis Review Manager version 5.1 software (Cochrane, 2011)
risk of stillbirth logor
Risk of stillbirth (LogOR*)

Study Weight

Odds Ratio

IV, Random, 95% CI

Odds Ratio, 95% CI

Franz 2009 9.1%

Gray 2007 7.5%

Kennare 2007 7.9%

Ohana 2011 12.9%

Reddy 2010 11.0%

Richter 2007 8.3%

Salihu 2006 12.8%

Smith 2007 9.7%

Taylor 2005 11.6%

Wood 2008 9.2%

Total (95% CI) 100.0%

1.30 [0.93, 1.81]

1.53 [1.00, 2.34]

1.56 [1.04, 2.33]

0.80 [0.71, 0.91]

1.30 [1.03, 1.64]

1.52 [1.05, 2.21]

1.10 [0.96, 1.25]

1.75 [1.30, 2.36]

1.10 [0.90, 1.35]

1.27 [0.92, 1.76]

1.25 [1.06, 1.49]

* Adjusted for: maternal age, history of pregnancy loss, smoking, diabetes, SES, BMI, ethnicity

sensitivity analysis adj or
Sensitivity analysis (adj. OR)
  • Cohort studies (n=9) OR=1.28 95% CI 1.05, 1.56
  • Cross-sectional (n=1) OR=1.10 95% CI 0.90, 1.35
  • Primiparous (n=7) OR=1.29 95% CI 1.12, 1.49
  • Multiparous (n=3) OR=1.13 95% CI 0.75, 1.72
sensitivity analysis adj or1
Sensitivity analysis (adj. OR)

Definition of stillbirth used:

  • All stillbirths (n=4) OR=1.15 95% CI 1.04, 1.27
  • Unexplained (n=5) OR=1.47 95% CI 1.24, 1.74
  • Antepartum (n=6) OR=1.27 95% CI 0.95, 1.70
risk of miscarriage crude or
Risk of miscarriage (crude OR)

Study Weight

Odds Ratio

M-H, Fixed, 95% CI

Odds Ratio, 95% CI

Hall 1989 4.1%

Hemminki 1985 1.3%

Hemminki 1986a 2.9%

Hemminki 1986b 5.3%

Hemminki 1996 21.2%

LaSala 1987 0.3%

Mollison 2005 11.2%

Smith 2006 52.2%

Tower 2000 1.5%

Total (95% CI) 100.0%

1.32 [1.06, 1.65]

1.10 [0.72, 1.69]

1.10 [0.82, 1.47]

1.12 [0.90, 1.38]

1.22 [1.10, 1.36]

1.26 [0.54, 2.92]

1.06 [0.92, 1.23]

1.07 [1.00, 1.15]

0.76 [0.48, 1.18]

1.11 [1.06, 1.17]

*

sensitivity analysis crude or
Sensitivity analysis (crude OR)
  • Extra study added OR=1.12 95% CI 1.07, 1.17
  • Cohort (n=7) OR=1.11 95% CI 1.06, 1.17
  • Case-control (n=1) OR=1.26 95% CI 0.54, 2.92
overall risk of fetal death crude or
Overall risk of fetal death (crude OR)

Odds Ratio

M-H, Random, 95% CI

Odds Ratio, 95% CI

Study Weight

Franz 2009 7.2%

Gray 2007 2.5%

Kennare 2007 2.9%

Ohana 2011 7.7%

Olusanya 2009 4.1%

Reddy 2010 5.0%

Richter 2007 3.0%

Salihu 2006 7.9%

Smith 2007 4.9%

Taylor 2005 5.7%

Wood 2008 4.0%

Subtotal (95% CI) 55.2%

I2 =71%

Hall 1989 5.2%

Hemminki 1985 2.2%

Hemminki 1986a 3.9%

Hemminki 1986b 5.5%

Hemminki 1996 8.5%

LaSala 1987 0.7%

Mollison 2005 7.2%

Smith 2006 9.4%

Tower 2000 2.1%

Subtotal (95% CI) 44.8%

I2 =20%

Total (95% CI) 100.0%

I2 =62%

1.00 [0.86, 1.16]

1.34 [0.90, 1.99]

1.43 [1.00, 2.06]

1.41 [1.24, 1.61]

1.04 [0.79, 1.37]

1.25 [0.99, 1.58] STILLBIRTH

1.35 [0.94, 1.93]

1.09 [0.96, 1.23]

1.97 [1.55, 2.49]

1.11 [0.91, 1.36]

1.32 [1.00, 1.76]

1.26 [1.12, 1.42]

1.32 [1.06, 1.65]

1.10 [0.72, 1.69]

1.10 [0.82, 1.47]

1.12 [0.90, 1.38] MISCARRIAGE

1.22 [1.10, 1.36]

1.26 [0.54, 2.92]

1.06 [0.92, 1.23]

1.07 [1.00, 1.15]

0.76 [0.48, 1.18]

1.12 [1.05, 1.20]

1.19 [ 1.11, 1.28] FETAL DEATH

OVERALL

conclusions
Conclusions
  • Women with a previous Caesarean delivery have an increased risk of:
    • Stillbirth by 25%
    • Miscarriage by 11%
  • Compared to women with a previous vaginal delivery
  • Residual confounding
conclusions1
Conclusions
  • Difficult to establish one unifying cause

- Two very different pregnancy outcomes

  • Further research warranted

- Population based, prospective

- Universal definition and classification of

outcomes recommended

- Sub-analyses by type of Caesarean delivery

(elective vs. emergency)

my phd research
My PhD Research
  • Register-based cohort study
  • Danish Civil Registration System (CRS) data, unique identifiers, information rich
  • 800,000+ primiparous women giving birth between 1982 and 2010; Survival analysis
  • Research question: Is a primary Caesarean delivery associated with an increase in sub-fertility in subsequent pregnancies, compared with a primary vaginal delivery?”

LINK: http://www.cpr.dk/cpr/site.aspx?p=198&ArticleTypeID=76.

acknowledgements
Acknowledgements

Prof. Louise Kenny, Dr. Patricia Kearney, Ms. Jennifer Lutomski, Prof. Richard Greene, Dr. Ali Khashan (University College Cork, Ireland), Prof. EsbenAgerbo and Dr. Tine Henriksen (Aarhus University, Denmark)