title: 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 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.
authors.affiliation: Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. Mildred.M.Ramirez @uth.tmc.edu
authors.forename: Mildred M
authors.initials: MM
authors.lastname: Ramirez
authors.forename: Sharon
authors.initials: S
authors.lastname: Gilbert
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Marshall
authors.initials: M
authors.lastname: Carpenter
authors.forename: Alan M
authors.initials: AM
authors.lastname: Peaceman
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
mesh_terms: 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