A study of labour and maternal outcome in cases of intrauterine fetal demise with previous one cesarean section

Intra uterine fetal death is a most traumatic event for the pregnant woman and her family. When they present to the obstetrician, the family’s immediate concern is to get the pregnancy terminated. When we are dealing with IUFD in a scarred uterus, the option of repeat cesarean takes the second place in front of vaginal trial, which carries the risk of rupture uterus with it. Thus this dilemmatic situation was taken up for this study to look at the most suitable management option of delivery of an IUFD in a scarred uterus. It was a retrospective observational study done in cases of women with IUFD with a previous history of one lower segment cesarean section done at Vani Vilas Hospital attached to Bangalore Medical College, Bangalore. The cases underwent termination either by cesarean or vaginal route some requiring labour induction. The success of induction, rate of cesasrean, complications, mortality, rupture uterus and other parameters were studied. Out of the 56 patients recruited, 74% had vaginal delivery (Both spontaneous and induced) only mechanical method of induction was used. Amongst the induced 29 patients, 22 delivered vaginally. One patient had rupture uterus. No maternal mortality was noticed. Other complications like sepsis, DIC did not occur in the study group. PPH and blood transfusions were comparable with other patients. In cases of IUFD with Previous one scar on the uterus, the policy of TOLAC should be kept open and the cases if selected carefully, high success rate may be achieved.