VBAC is viable option after fetal demise, study suggests.(Obstetrics)

LOS ANGELES -- Vaginal delivery is a viable option for most women who've had a previous cesarean section and experience intrauterine fetal demise in a subsequent pregnancy, Mildred M. Ramirez, M.D., and her colleagues reported at the annual meeting of the Society for Gynecologic Investigation.

In a study of 209 women who faced this difficult situation, vaginal birth after cesarean section (VBAC) had an 86.7% success rate in 158 women who chose this procedure, according to the researchers' poster presentation.

Dr. Ramirez said in an interview that VBAC's success rate in this population was higher than in live births. She attributed the procedure's efficacy to there being no need for normal fetal monitoring and other attention to the well-being of the fetus.

A total of 51 women had a repeat cesarean section without attempting vaginal delivery. The surgical procedure was elective and not medically indicated in 37% of these patients, said Dr. Ramirez of the University of Texas Health Science Center at Houston Medical School.

The study involved data from the National Institute of Child Health and Human Development's Maternal Fetal Medicine Units (MFMU) Network. It represents a new subset analysis from a published observational study of more than 33,000 women in 19 hospitals (N. Engl. J. Med.2004; 351:2581-9; N. Engl. J. Med. 2004; 351:2647-9).

Only women with antepartum singleton pregnancies that resulted in intrauterine fetal demise at or after 20 weeks or when the fetus weighed at least 500 g were included in the new analysis. More than two-thirds of the women had undergone only one prior cesarean delivery; the rest had at least two. A total ...