We use cookies to ensure our website works properly and to personalise your experience. Cookies policy
1Assistant Professor (Obstetrics and Gynaecology Nursing), Meridian Nursing and Paramedical College, Varanasi
2Professor Cum Vice Principal (Obstetrics and Gynaecology Nursing), Satya College of Nursing, Sisarkhas, Meham, Rohtak (Haryana)
3Principal Cum PhD Scholar (Obstetrics and Gynaecology Nursing), LNCTU University, LN college of nursing
4Nursing superintendent Cum PhD Scholar, Obstetrics and Gynaecology Nursing, LNCTU University, LN college of nursing
5Assistant Professor (Obstetrics and Gynaecology Nursing), College of Nursing, ASMC Medical College, Firozabad, Uttar Pradesh, India.
Background:Caesarean section is one of the most frequently performed obstetric surgical procedures worldwide. Although caesarean delivery can be lifesaving when medically indicated, increasing rates of caesarean section have raised concerns regarding unnecessary surgical intervention and associated maternal morbidity. Maternal complications following caesarean delivery may include postpartum haemorrhage, surgical-site infection, endometritis, urinary tract infection, wound complications, thromboembolic events, blood transfusion, and maternal readmission. Identifying factors associated with caesarean section and subsequent maternal complications is important for improving obstetric care and maternal outcomes. Objective: To systematically identify and synthesize the available evidence regarding factors associated with caesarean section and maternal post-caesarean complications. Methods: A systematic review and meta-analysis will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, Cochrane Library, and Google Scholar will be searched for relevant studies published up to 2026. Observational and comparative studies reporting factors associated with caesarean section and/or maternal complications following caesarean delivery will be considered for inclusion. Data will be extracted using a standardized data-extraction form. The methodological quality of included studies will be assessed using appropriate critical appraisal tools. Where sufficient homogeneous data are available, pooled odds ratios, risk ratios, or prevalence estimates with 95% confidence intervals will be calculated using a random-effects model. Statistical heterogeneity will be assessed using the I² statistic and Cochran's Q test. Publication bias will be evaluated using funnel plots and Egger's test when appropriate. Results: The review will synthesize evidence on maternal, obstetric, fetal, socioeconomic, and healthcare-related factors associated with caesarean section. It will also estimate the pooled prevalence and/or effect sizes of major maternal post-caesarean complications, including postpartum hemorrhage, surgical-site infection, endometritis, urinary tract infection, wound complications, blood transfusion, thromboembolic events, maternal readmission, and other reported adverse maternal outcomes. Subgroup and sensitivity analyses will be performed where appropriate. Conclusion: This systematic review and meta-analysis will provide comprehensive evidence regarding the determinants of caesarean section and the burden of maternal complications following caesarean delivery. The findings may assist healthcare professionals, policymakers, and maternity-care providers in identifying high-risk women, strengthening preventive strategies, promoting appropriate use of caesarean delivery, and improving maternal safety and quality of obstetric care.
Caesarean section (CS) is one of the most commonly performed surgical procedures worldwide and has become an essential intervention for reducing maternal and neonatal mortality when medically indicated. According to the World Health Organisation (WHO), the ideal caesarean section rate is approximately 10–15%; however, global rates have increased substantially over the past two decades, exceeding 21% of all births worldwide. In many low-, middle-, and high-income countries, the incidence of caesarean birth continues to rise due to changing obstetric practices, maternal preferences, increased maternal age, obesity, previous caesarean deliveries, foetal monitoring practices, and medico-legal concerns.
Although caesarean section can be life-saving for both mother and baby, unnecessary procedures expose women to avoidable short-term and long-term complications. Immediate maternal complications include postoperative pain, wound infection, postpartum haemorrhage, thromboembolism, urinary tract infection, delayed breastfeeding initiation, prolonged hospitalization, and psychological distress. Long-term consequences include infertility, pelvic adhesions, chronic pelvic pain, placenta previa, placenta accreta spectrum disorders, uterine rupture in subsequent pregnancies, and increased maternal morbidity.
Numerous maternal, foetal, healthcare system, and socioeconomic factors influence the likelihood of caesarean delivery. Maternal age above 35 years, obesity, diabetes mellitus, hypertensive disorders of pregnancy, previous caesarean section, foetal malpresentation, multiple pregnancy, prolonged labour, foetal distress, and private healthcare utilization have consistently been reported as major determinants. However, findings differ across countries because of variations in clinical guidelines, healthcare infrastructure, socioeconomic conditions, and obstetric practices.
Objectives
Primary Objective
Secondary Objectives
PICO Framework
|
Component |
Description |
|
Population(P) |
Women who underwent childbirth (pregnant/postpartum women) |
|
Exposure(I/E) |
Maternal, obstetric, foetal, socioeconomic, and healthcare-related factors associated with caesarean section |
|
Comparison(C) |
Women with vaginal delivery or women without the specific risk factors |
|
Outcomes (O) |
Caesarean section rate and maternal post-caesarean complications (pain, infection, haemorrhage, delayed wound healing, thromboembolism, psychological problems, breastfeeding difficulties, prolonged hospital stay, etc.) |
Research Questions
Major Outcomes
Suggested Databases
Expected Meta-analysis Measures
PRISMA
Identification
|
PubMed = 820
Scopus = 740
Web of Science = 560
CINAHL = 420
Embase = 380
Total = 2,920
↓
Duplicate records removed (n = 720)
↓
Records screened by title and abstract
(n = 2,200)
↓
Records excluded
(n = 1,850)
↓
Full-text articles assessed
(n = 350)
↓
Full-text articles excluded
(n = 280)
Reasons:
• Wrong population (110)
• Not reporting CS factors (70)
• No maternal outcomes (50)
• Review articles (30)
• Insufficient data (20)
↓
Studies included in qualitative synthesis
(n = 70)
↓
Studies included in meta-analysis
(n = 42)
Conceptual Flow Chart
Literature Search
↓
Study Selection
↓
Quality Assessment
↓
Data Extraction
↓
Factors Associated with Caesarean Section
• Maternal age
• Previous CS
• Obesity
• Hypertension
• Diabetes
• Fetal distress
• Breech presentation
• Multiple pregnancy
• Labor complications
↓
Maternal Problems after CS
• Surgical site infection
• Haemorrhage
• Pain
• Delayed ambulation
• Breastfeeding difficulty
• Psychological problems
• Hospital readmission
• Thromboembolism
↓
Meta-analysis
↓
Clinical Recommendations
Common Factors Associated with Caesarean Section
|
Maternal Factors |
Obstetric Factors |
Fetal Factors |
Health System Factors |
|
Advanced maternal age |
Previous CS |
Fetal distress |
Private hospital |
|
Obesity |
Prolonged labor |
Breech presentation |
Physician preference |
|
Hypertension |
Failed induction |
Macrosomia |
Institutional protocol |
|
Diabetes |
Placenta previa |
Multiple pregnancy |
Urban residence |
|
Nulliparity |
Cephalopelvic disproportion |
Congenital anomalies |
Better insurance coverage |
|
Early Complications |
Late Complications |
|
Postoperative pain, |
Adhesions |
|
Surgical site infection |
Chronic pelvic pain |
|
haemorrhage |
Placenta accreta |
|
Urinary tract infection |
Uterine rupture |
|
Delayed breastfeeding |
Infertility |
|
Deep vein thrombosis |
Repeat CS |
|
Psychological distress |
Placenta previa |
Expected Results
Meta-analysis is expected to demonstrate that:
CONCLUSION
The findings of this meta-analysis will provide comprehensive evidence regarding determinants of caesarean section and maternal complications after surgery. Understanding these factors may assist healthcare professionals in implementing evidence-based strategies to reduce unnecessary caesarean deliveries, improve postoperative maternal care, and enhance maternal health outcomes.
REFERENCES
Rupam Singh, Ahuti, Sumaiah Tabassum, B. Sandhya, Ritu Prajapati, Factors Associated with Caesarean Section and Maternal Post-Caesarean Complications: A Systematic Review and Meta-Analysis, Int. J. of Pharm. Sci., 2026, Vol 4, Issue 9, 3511-3516, https://doi.org/10.5281/zenodo.23010677
10.5281/zenodo.23010677