What is the meaning of interpregnancy interval after caesarean section for women planning further pregnancies: a mixed method systematic review protocol

Background: Caesarean section rates are increasing globally. Caesarean section and repeat caesarean section increase risk in the next pregnancy. Risks associated with next pregnancy after caesarean section for both the mother and fetus are well documented including placentation anomalies, uterine rupture, small for gestational age neonates and preterm birth. Interpregnancy interval may play a role in reducing risk in the next pregnancy. It is therefore important to understand the meaning of interpregnancy interval to women planning further pregnancies after caesarean section. Appreciating interpregnancy interval from women’s perspective can improve the sharing of interpregnancy interval recommendations relevant to women for informing their decision making.

Methods: The review will include all studies exploring women’s knowledge, understanding and decision making when planning another pregnancy after caesarean section and will follow the JBI methodology for mixed methods reviews using a convergent integrated approach, reported as per the preferred reporting items for systematic reviews and meta-analysis (PRISMA). A search strategy will be used to find published and unpublished studies in CINHAL, Medline, Embase, Psycinfo and SCOPUS. No limitation will be placed on study type, language of publication, or date range. All studies will be screened against the inclusion criteria, all data extracted critically appraised for methodological quality using JBI tools by two independent reviewers. Integrated findings will be presented as line of action statements. Confidence in the textual synthesis will be presented in a table.

Discussion: This review aims to integrate research exploring the meaning of interpregnancy interval to women after a caesarean section when planning further pregnancies. This systematic review holds implications for practice and informed decision making, for a next pregnancy after caesarean section in the context of newfound risk and reproductive life planning.

Systematic review registration: Protocol registered with PROSPERO CRD42024552081