Maternal morbidity and mortality associated with delivery after intrauterine fetal death.

OBJECTIVE 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. DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Labour Room, Nishtar Hospital, Multan from January to December 2003. 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. RESULTS There were 1834 live birth and 63 deliveries with intrauterine fetal death. Mode of delivery was vaginal in 87.4% and cesarean section in 12.6% of the cases. Twelve (21%) of the vaginal deliveries were complicated by lower urogenital tract injuries in certain cases, whereas 75% (6/8) 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. CONCLUSION 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.