Introduction: Sociocultural factors affect acceptance of invasive fetal viability interventions, like in utero procedures, urgent cesarean decision-making, and prophylactic tocolysis. This review reflected the views of patients and healthcare providers on sociocultural barriers to invasive fetal-preserving interventions and estimated the prevalence of refusal or reluctance in quantitative studies. Methods: From inception to June ۲۰۲۵, PubMed, Embase, Scopus, PsycINFO, CINAHL, and Web of Science were searched extensively. The search included 'fetal preservation,' 'invasive intervention,' 'in utero,' 'acceptance,' 'refusal,' 'culture,' 'beliefs,' 'patient perspective,' and 'healthcare provider.' Qualitative, quantitative, and mixed-methods studies on pregnant populations' and healthcare providers' acceptance and refusal of invasive fetal-preserving interventions were included. Without primary data, case reports, editorials, and studies were excluded. Two reviewers independently screened, extracted data, and assessed study quality using the CASP for qualitative studies, the Newcastle-Ottawa Scale for quantitative studies, and the Mixed Methods Appraisal Tool for mixed designs. Thematic synthesis was done on qualitative data. A random-effects meta-analysis of proportions (DerSimonian-Laird) was employed to aggregate quantitative prevalence data, and heterogeneity was assessed using the I² statistic. Results: The analysis included ۴۶ studies (n = ۹,۲۱۴ participants: ۶,۱۲۰ patients and ۳,۰۹۴ providers). Designs include ۲۲ qualitative, ۱۲ quantitative, and ۱۲ mixed-methods surveys. Mistrust of interventions and institutions, religious and moral objections, limited health literacy, family and community decision-making dynamics, and perceived risks to maternal status were identified through thematic synthesis. Based on ۲۴ quantitative estimates, the prevalence of patient-reported refusal or reluctance was ۰.۳۳ (۹۵% CI, ۰.۲۷–۰.۴۰; I² = ۷۹%). Across ۱۵ estimates, the providers' reluctance to recommend invasive interventions was ۰.۲۹ (۹۵% CI, ۰.۲۳-۰.۳۶; ۱² = ۷۲%). Subgroup analyses revealed that strong communal decision-making norms were associated with increased refusal. Conclusion: Numerous sociocultural barriers affect the acceptance of invasive fetal-preserving interventions. Uptake interventions must emphasize community engagement, culturally sensitive counseling, and provider training. Subsequent research should evaluate strategies using robust mixed-methods designs. Policymakers should utilize these findings to tailor consent pathways and inform implementation research.
