Table 2.
Meta-analytic results for maternal health outcomes, comparing modes of delivery.
| ECS versus vaginal delivery | ECS versus all other modes of delivery | |||||||||
| No. of articles | No. of effect sizes | No. of participants | OR (95% CI) | I2 | No. of articles | No. of effect sizes | No. of participants | OR (95% CI) | I2 | |
| RCTs | ||||||||||
| Postpartum fever | 1 [42] | 1 | 414 | 5.12 (1.48–17.75)c | – | – | – | – | – | – |
| Wound infection | 1 [42] | 1 | 414 | 1.71 (0.31–9.44)c | – | – | – | – | – | – |
| Anesthetic | 1 [42] | 1 | 414 | 4.28 (0.20–89.72)c | – | – | – | – | – | – |
| Anemia | 1 [42] | 1 | 414 | 3.03 (0.62–14.77)c | – | – | – | – | – | – |
| Other complications | 1 [42] | 1 | 414 | 0.63 (0.14–2.85)c | – | – | – | – | – | – |
| Observational studies | ||||||||||
| Mortality in the first year postpartum | 1 [48] | 0d | 427 | – | – | 1 | 0c | 501 | – | – |
| All morbiditiesb | 6 [17,19,22,36,38,49] | 7 | 7821 | 3.12 (2.21–4.41) | 58.14 | 5 [17,19,36,38,49] | 5 | 7893 | 1.52 (1.06–2.20) | 65.29 |
| All morbidities, LMICs onlya | 1 [19] | 1 | 559 | 1.16 (0.49–2.71) | N/Ae | 1 [19] | 1 | 697 | 0.73 (0.35–1.51) | N/Ae |
| UTI or febrile UTI | 6 [17,19,22,36,41,49] | 7 | 5683 | 1.85 (1.18–2.88) | 0 | 5 [17,19,36,41,49] | 6 | 6672 | 1.18 (0.80–1.76) | 0 |
| UTI or febrile UTI, LMICs onlya | 1 [19] | 1 | 559 | 1.57 (0.84–2.92) | N/Ae | 1 [19] | 1 | 697 | 1.06 (0.62–1.79) | N/Ae |
| Endometritis, febrile endometritis, or amnionitis | 5 [17,22,36,41,49] | 5 | 5124 | 1.53 (0.68–3.44) | 40.62 | 4 [17,36,41,49] | 4 | 5975 | 1.17 (0.65–2.12) | 0 |
| Hemorrhage, transfusion, or severe anemia | 5 [17,22,36,41,49] | 7 | 5433 | 1.91 (1.20–3.03) | 3.14 | 4 [17,36,41,49] | 6 | 5975 | 1.83 (1.07–3.1) | 20.76 |
CI, confidence interval; ECS, elective c-section; LMIC, low-income/middle-income countries; OR, odds ratio; RCT, randomized controlled trial; UTI, urinary tract infection.
aIncluded studies were conducted in countries classified as lower income, lower-middle, or upper-middle income by the World Bank.
bAll morbidities refers to any major or minor postpartum complication, including abscess, amnionitis, anemia, anesthesia complications, cystitis, deep vein thrombosis, diffuse intravascular dissemination, endometritis, fever, hematoma, hemorrhage, peritonitis, pneumonia, pneumopathy, postpartum operation, pyelonephritis, sepsis, septic pelvic thrombophletitis, septic shock syndrome, subileus, transfusion (red blood cell/platelet), UTI, wound (caesarean incision or episiotomy) infection or dehiscence.
cOR and 95% CI were not reported in the text; these statistics were calculated from data presented in tables.
dOne study presented maternal mortality outcomes. ORs were not calculable given the lack of events in the ECS group. Eight deaths were reported of the 405 women delivering vaginally, five of the 74 given non-ECS, and none of the 22 given ECS.
eNot applicable, as meta-analysis was not conducted when there was only a single effect size.