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

OBJECTIVE: To assess the incidence and conditions associated with cesarean section in a cohort of pregnant women with intrauterine fetal death (IUFD), and clinical management to anticipate the childbirth. METHODS: It was a retrospective cohort study with 163 mothers with IUFD, at the second half of pregnancy, who were managed to anticipate childbirth using pharmacological preparations and/or a mechanical method (Foley catheter) in a teaching hospital in Rio de Janeiro State, Brazil. Cox regression was used to evaluate the effect of the clinical methods on the kind of delivery. RESULTS: The Subgroups A (misoprostol or Oxytocin), B (misoprostol and Oxytocin), and C (Foley catheter alone or combined with misoprostol and/or Oxytocin) were formed according to the applied methods. Nine out of 163 cases ended with cesarean section. The incidence of cesarean section was 3.5 per 1,000 people-hours, meaning that a pregnant woman with IUFD had a 15.6% risk of cesarean section during the first 48 hours of clinical management to anticipate childbirth. The conditions significantly associated with the mode of delivery were placental abruption (HR: 44.97), having two or more previous cesarean deliveries (HR: 10.03), and mechanical method with Foley catheter (HR: 5.01). CONCLUSION: Cesarean section was an essential conduct in this cohort and followed previous cesarean delivery and placental abruption. The effect of the mechanical method on the abdominal route suggests that the Foley catheter method was used in the most difficult cases and that the surgery was performed to ensure maternal health.

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Management of stillbirths: an observational analysis at a rural tertiary care centre in Kerala, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191222 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1583

Author(s):

Ajini K. K. ◽

Reena R. P. ◽

Radha K. R.

Keyword(s):

Cesarean Section ◽

Fetal Death ◽

Tertiary Care ◽

Induction Of Labour ◽

Intrauterine Fetal Death ◽

Elective Cesarean Section ◽

Care Centre ◽

Tertiary Care Centre ◽

Elective Cesarean ◽

Previous Cesarean

Background: Stillbirth is a distressing event, both for the expecting mother and the obstetrician. Several maternal, social and circumstantial factors influence its occurrence. These women with intrauterine fetal death need to be treated in a considerate manner. Our aim was to analyse different methods of induction, management of labour and their outcomes in women with antepartum fetal demise.Methods: All women admitted to a tertiary care centre with intrauterine fetal death after 22 weeks during the study period of 24 months were recruited. Maternal sociodemographic characteristics and relevant investigations were studied. Induction of labour was achieved with mechanical and pharmacological methods. Stillborn babies, placentae and umbilical cord were examined after delivery.Results: There were 175 women with IUFD admitted during the study period. The stillbirth rate was 38.6 per1000 live births.148 women (84.57%) required induction of labour while16 women had spontaneous onset of labour. Among the 44 women with previous Cesarean section, 11 underwent elective Cesarean section. 19 women (57.6%) out of 33 cases of trial of labour after Cesarean had a successful vaginal delivery. There were 2 cases of rupture uterus and 10 women required ICU admissions. Intrauterine growth restriction was the leading cause of stillbirth (41.8%) followed by hypertensive disorders (27.7%).Conclusions: Present study has shown that vaginal birth can be achieved in most women with mechanical and pharmacological methods of induction within a reasonable period of time.

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Maternal Morbidity and Mortality Associated with Delivery after Intrauterine Fetal Death

Bangladesh Medical Journal ◽

10.3329/bmj.v38i2.3571 ◽

1970 ◽

Vol 38 (2) ◽

pp. 39-43

Author(s):

Shahin Akter Jahan Habib ◽

Sayeeda Sultana

Keyword(s):

Cesarean Section ◽

Live Birth ◽

Maternal Death ◽

Maternal Morbidity ◽

Fetal Death ◽

Mode Of Delivery ◽

Morbidity And Mortality ◽

Intrauterine Fetal Death ◽

Vaginal Deliveries ◽

Maternal Morbidity And Mortality

To determine the maternal morbidity and mortality associated with delivery after intrauterine fetal death (IUFD) and to find out the place of fetal destructive procedures and cesarean section. The study design was Cross-sectional. The place of study was conducted in the Labour Room, Dhaka Medical College Hospital Dhaka from January 2005 to December 2005.Patients and Methods: All women were included in the present study who presented before the onset of labour pains, after intrauterine fetal death at 26 weeks or onward with singleton pregnancy. Assessment of maternal demographic characteristics, gestational age at fetal demise, delivery -IUFD interval, mode of delivery; vaginal with or without fetal destructive procedures/cesarean section and maternal complications were the main outcome measures. There were 5,502 live birth and 189 deliveries with intrauterine fetal death. Mode of delivery was vaginal in 87.4% and cesarean section in 12.6% of the cases. Thirty six (21%) of the vaginal deliveries were complication by lower urogenital tract injuries in certain cases, whereas 75% (18/24) of patients delivered by cesarean section developed major postoperative complications like postpartum haemorrhage , shock, endometritis, peritonitis and wound dehiscence. No maternal death was identified. Rate of delivery with intrauterine fetal death was 34.3/1000 live -birth deliveries. Maternal morbidity like perineal tear, urinary tract infection, menstrual disorder and even secondary infertility may follow after vaginal mode of delivery by forceps and destructive procedures. The frequency and severity of complications after cesarean delivery are quite higher and may rarely lead to even maternal death. Key Words: Intrauterine fetal death. Maternal morbidity. DOI: 10.3329/bmj.v38i2.3571 Bangladesh Medical Journal 38(2) 2009 39-43

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Efficacy and Safety of Foley Catheter Balloon for Cervix Priming in Term Pregnancy

Acta Médica Portuguesa ◽

10.20344/amp.8003 ◽

2017 ◽

Vol 30 (4) ◽

pp. 281 ◽

Cited By ~ 2

Author(s):

Catarina Policiano ◽

Mariana Pimenta ◽

Diana Martins ◽

Nuno Clode

Keyword(s):

Foley Catheter ◽

Mode Of Delivery ◽

Tertiary Hospital ◽

Mechanical Effect ◽

Induction Of Labor ◽

Catheter Removal ◽

Bishop Score ◽

Delivery Time ◽

Singleton Pregnancy ◽

Previous Cesarean

Introduction: Foley catheter promotes cervix priming by a direct mechanical effect of distension.Material and Methods: A prospective observational study was conducted at a tertiary hospital, including all cases of induction of labor with Foley catheter between September 1, 2013 and November 30, 2015. Women were eligible if they had a singleton pregnancy with a Bishop score < 6 and a gestational age ≥ 41 weeks or a medical indication for induction of labor. The primary outcome was the Bishop score variation (difference between Bishop score before and after insertion of Foley catheter). Mode of delivery, induction-to-delivery time, uterine tachysystole with fetal decelerations, peripartum fever ≥ 38º C, maternal pain and mortality were also analyzed.Results: Within 201 inductions with Foley catheter, average increase in Bishop score after catheter placement was three (1 - 7), with only 5% (11/201) of unmodified cervix after catheter removal/extrusion. Vaginal delivery rate was 71% (142/201) and in women with a previous cesarean section (n = 40) was 37% (15/40). Average induction-to-delivery time was 38 hours (4 - 120). Uterine infection rate was 3% (6/201). There was only one case of significant vaginal bleeding which required immediate catheter removal. There has been no significative maternal or neonatal morbidity.Discussion/Conclusion: Foley catheter is a safe and effective method of cervical priming for women with an unfavorable cervix, even in the case of a previous cesarean delivery.

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Cesarean section and offspring’s risk of multiple sclerosis: a Danish nationwide cohort study

Multiple Sclerosis Journal ◽

10.1177/1352458513480010 ◽

2013 ◽

Vol 19 (11) ◽

pp. 1473-1477 ◽

Cited By ~ 11

Author(s):

Nete M Nielsen ◽

Peter Bager ◽

Egon Stenager ◽

Bo V Pedersen ◽

Nils Koch-Henriksen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cesarean Section ◽

Cox Regression ◽

Mode Of Delivery ◽

Study Cohort ◽

Cox Regression Analysis ◽

Medical Birth Register ◽

Increased Risk ◽

Rate Ratios ◽

Log Linear

Background: Apart from a recent study reporting a 2- to 3-fold increased risk of multiple sclerosis (MS) among women and men who were delivered by Cesarean section (C-section), little attention has been given to the possible association between mode of delivery and the risk of MS. Objectives: We studied the association between C-section and risk of MS, in a cohort of 1.7 million Danes born from 1973 to 2005. Methods: Information on C-section and MS was obtained from the Danish Medical Birth Register and the Danish MS Register, respectively. The association between C-section and MS was evaluated by means of MS incidence rate ratios (RR) with 95% confidence intervals (CI) obtained in log-linear Poisson regression analyses. Results: There were 930 cases of MS in the study cohort, of whom 80 (9%) were delivered by C-section. Overall, we found there was no significant association between C-section and risk of MS (RR = 1.17; 0.92–1.46). Analyses stratified by sex revealed no unusual risk of MS for women (RR = 1.08: 0.80–1.42) nor men (RR = 1.37: 0.91–1.98). A supplementary sibling-matched Cox regression analysis likewise suggested there was no excess risk of MS in persons delivered by C-section (HR = 1.03; 0.63–1.69). Conclusions: Mode of delivery appears to be unimportant in relation to MS development in the offspring.

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Scar thickness measurement by transvaginal sonography in late second trimester and third trimester in pregnant patients with previous cesarean section: does sequential change in scar thickness with gestational age correlate with mode of delivery?

Journal of Ultrasound ◽

10.1007/s40477-014-0116-3 ◽

2014 ◽

Vol 18 (2) ◽

pp. 173-178 ◽

Cited By ~ 6

Author(s):

Nilanchali Singh ◽

Reva Tripathi ◽

Y. M. Mala ◽

Rashmi Dixit

Keyword(s):

Cesarean Section ◽

Gestational Age ◽

Mode Of Delivery ◽

Thickness Measurement ◽

Transvaginal Sonography ◽

Second Trimester ◽

Previous Cesarean Section ◽

Third Trimester ◽

Sequential Change ◽

Previous Cesarean

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A prospective study of intrauterine death cases at a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210319 ◽

2021 ◽

Vol 10 (2) ◽

pp. 638

Author(s):

Nabila N. Tai ◽

Rinku Mulchandani ◽

Dipti A. Modi ◽

Bijal Rami

Keyword(s):

Prospective Study ◽

Fetal Death ◽

Tertiary Care ◽

Mode Of Delivery ◽

Intrauterine Fetal Death ◽

Intrauterine Death ◽

Care Hospital ◽

Risk Pregnancy ◽

A Prospective Study ◽

Death Cases

Background: Intrauterine fetal death is defined as foetus with no signs of life in utero after 20 weeks of gestations. Stillbirth is a useful index to measure the values of antenatal and intra-natal care. Intrauterine fetal death is due to various causes whether it be maternal causes, fetal causes or placental causes.Methods: It was a prospective study, conducted at SSG hospital, Vadodara over a period of 1 year from January 2019 to December 2019. All pregnant women coming to labour room with intrauterine fetal death with gestation age more than 28 weeks were included in study. It included complaints on admission, obstetric profile, mode of delivery, fetal outcomes, placental examination, condition of cord and investigation reports.Results: During the study period of one year, a total of 462 intrauterine fetal deaths were reported amongst 7295 deliveries conducted during the study period. Incidence rate calculated was 63/1000 births. Many of the intrauterine fetal death cases were associated with pregnancy induced hypertension and antepartum hemorrhage. Out of all intrauterine death cases, 410 cases delivered vaginally. Congenital anomalies were also found to be associated with intrauterine death cases.Conclusions: High risk pregnancy cases should be identified during routine antenatal check-ups so that intrauterine fetal death can be prevented. The mode of antepartum and intrapartum surveillance for fetal wellbeing should be advanced to prevent fetal demise.

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Outcomes of induction in trial of labor after cesarean delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190882 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1076

Author(s):

Anubha Varshney ◽

Zehra Mohsin

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Induction Of Labor ◽

Control Group ◽

Study Group ◽

Previous Cesarean Section ◽

Trial Of Labor ◽

Previous Cesarean

Background: The objective of this study is to evaluate the outcomes of induction of labor in women attempting trial of labor after cesarean delivery and to compare maternal and neonatal morbidity and mortality in women who were induced to those delivering spontaneously.Methods: The prospective study was carried out in the Department of Obstetrics and Gynecology in collaboration with the Neonatal Section, Department of Pediatrics at J.N. Medical College and Hospital, AMU Aligarh. The sample included 280 women with one previous cesarean section, of whom 130 women underwent induction of labor (study group) and 150 were admitted with spontaneous onset of labor. Prostaglandin gel and intracervical Foley’s were used for cervical ripening in the study group. Indication of cesarean section, mode of delivery, maternal and neonatal outcome were studied in between groups.Results: Overall rate of vaginal delivery after cesarean section was 45.3% and 56% in both study and control group respectively. The rate of cesarean section were higher in women who were induced and having unfavorable cervix. Maternal and neonatal morbidity were not significantly higher as compared in both groups, however one case of scar rupture was found in study group.Conclusions: Induction of labor in women with previous cesarean section had higher rates of cesarean section however it does not adversely affect neonatal and maternal morbidity. Overall vaginal birth is safe and effective in women with previous cesarean section by prostaglandin gel or intracervical Foley’s. Authors cautiously suggest, induction of labor should be considered in preselected patient with strict monitoring.

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