A comparative systematic review and meta-analysis of uterine artery resistance in pregnant women with and without previous history of cesarean section

PMCID: PMC12176234

PMID: 40531956

DOI: 10.1371/journal.pone.0325352

Journal: PloS one

Publication Date: 2025-6-18

Authors: Mohazzab A, Mohammadzadeh A, Nikfar B, Masoumi S, Shoraka E, et al.

Key Points

• A history of cesarean section may be associated with slightly increased uterine artery resistance
• Small but statistically significant effect: Hedges's g = 0.15 for pulsatility index
• Recommend careful monitoring of uterine artery resistance in subsequent pregnancies for women with prior cesarean sections

Summary

This systematic review and meta-analysis investigated the potential relationship between a history of cesarean section and uterine artery resistance in subsequent pregnancies using Color Doppler ultrasonography. Analyzing six studies encompassing 1,656 participants from multiple countries, the research sought to clarify conflicting literature on this clinical question. The meta-analysis revealed a small but statistically significant increase in uterine artery pulsatility index (PI) among women with previous cesarean sections, with a Hedges's g of 0.15 (95% CI [0.03, 0.26], p = 0.01).

The study's findings suggest a potential clinical implication for monitoring uterine artery resistance in subsequent pregnancies, particularly for women with a cesarean section history. While the effect size is modest, the consistent results across studies (with low heterogeneity, I² = 26.60%) warrant further investigation. The researchers emphasize the need for additional research to definitively establish the clinical relevance of these findings and their potential implications for predicting pregnancy complications such as preeclampsia or intrauterine growth restriction.