Mode of Delivery in Women with Antepartum Fetal Death and Prior Cesarean Delivery

Abstract

We describe obstetric outcomes in a group of patients with prior cesarean delivery (CD) presenting with an intrauterine fetal demise (IUFD). A secondary analysis of an observational study of women with prior CD was performed. All antepartum singleton pregnancies with a prior CD and IUFD ≥ 20 weeks’ gestation or 500 grams were evaluated. Two hundred nine patients met inclusion criteria for analysis. The mean gestational age ± standard deviation at delivery was 31.3 ± 6.5 weeks. The trial of labor rate was 75.6% (158/209), and the vaginal birth after cesarean (VBAC) success rate was 86.7%. Labor induction or augmentation occurred in 83.3% of attempted VBAC. Uterine rupture occurred in five women (2.4%), and in 3.4% of those being induced but none of these required hysterectomy. Women with a history of previous CD and an IUFD often undergo trial of labor with a high VBAC success rate. Uterine rupture complicates 2.4% of such cases.

Maternal complications associated with stillbirth delivery: A cross-sectional analysis

“…This information is consistent with previous research demonstrating that even among women with prior cesarean delivery, there is a high success rate of vaginal birth among women with IUFD. (Ramirez et al 2010)…”

Clinical management of the induction of labor in intrauterine fetal death: evaluation of incidence of cesarean section and related conditions

“…There is evidence of increased risk of dead fetus after cesarean section delivery 21 , suggesting a complex cycle of maternal and perinatal morbimortality of difficult solution, which is frequently faced by health teams. Therefore, there is the risk of not only having to perform a later C-section, but also of a greater surgery like puerperal hysterectomy after a possible uterine rupture 22 . Although no case of uterine rupture has happened, it has been seen that previous history of two or more cesarean sections increased in ten times the risk of IUFD delivery through repetition of cesareans.…”

Ultrasonography of the uterus within 6 weeks following Cesarean section

“…Incidence of Cesarean scar ectopic pregnancy is about 1 in 2000 pregnancies [29], and early diagnosis is vital to institute uterus-saving therapy. Uterine rupture complicates about 2.4% of the vaginal births after cesarean section [30]. We suppose in any case, that women with severe CS scar defect have much higher risk of uterine rupture by vaginal birth after CS, and that the above percentage does not reflect the risk factors for rupture.…”