Mode of delivery in women with antepartum fetal death and prior cesarean delivery.
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 g 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.
Ramirez
Mildred M
MM
Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. Mildred.M.Ramirez @uth.tmc.edu
Gilbert
Sharon
S
Landon
Mark B
MB
Rouse
Dwight J
DJ
Spong
Catherine Y
CY
Varner
Michael W
MW
Caritis
Steve N
SN
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
Peaceman
Alan M
AM
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Mercer
Brian M
BM
D000328:Adult; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D020073:Gravidity; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000209:etiology; D011247:Pregnancy; D050497:Stillbirth; D016896:Treatment Outcome; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*; D055815:Young Adult