Systematic review of the effects of birth spacing after cesarean delivery on maternal and perinatal outcomes

Abstract

Background: Little is known about the association between birth spacing and subsequent pregnancy outcomes after cesarean delivery.

Objectives: To summarize the effects of birth spacing after previous caesarean on maternal and perinatal outcomes.

Search strategy: Four online databases were searched via a multistage search strategy.

Selection criteria: Studies assessing the effects of birth spacing on any adverse pregnancy outcome after cesarean were included.

Data collection and analysis: A narrative synthesis was completed.

Main results: Fifteen studies were included. Eight reported that interpregnancy interval (IPI) shorter than 6 months or birth interval (BI) shorter than 16-18 months increased the risk of uterine rupture during trial of labor after previous cesarean. Most studies found no association of birth spacing with vaginal delivery success following spontaneous labor, but the association with vaginal delivery after induced labor was less certain. BI shorter than 12 months was associated with increased risk of placenta previa and placental abruption. Few studies examined the effect of birth spacing after previous cesarean on perinatal outcomes.

Conclusions: IPI longer than 6-8 months or BI longer than 18 months was related to decreased risk of maternal morbidity and failed vaginal delivery after previous cesarean.

Keywords: Abnormal placentation; Adverse pregnancy outcomes; Birth spacing; Cesarean delivery; Systematic review; Trial of labor after cesarean; Uterine rupture; Vaginal birth after cesarean.