Role of Intracervical Catheterization for Induction of Labour in Case of Intrauterine Featal Death with History of Previous Caesarean Section

Author(s): Dr. Fatema Akter Doly, Dr. Kazi. Mst Sadeka Tamanna, Professor. Dr. Salma Rouf, Professor. Dr. Anwar Begum, Dr. Farzana Mahmood, Dr. Mahbubur Rahman Razeeb, Dr. Sarmin Sultana Swarna, Dr. Imran Mahmud

Background:

Induction of labour is a common obstetric procedure. Both mechanical (eg, Foley catheters) and pharmacological methods (eg, prostaglandins) are used for induction of labour in women with an unfavourable cervix. Intrauterine fetal death is the most undesirable consequence of pregnancy, when it occur it carries a time related risk of consumption coagulopathy and psychological distress. Various methods have been described to induce labor are available. But when patient presents with fetal death along with previous caesarean section delivery choice of suitable method of induction is always difficult because of chance of scar rupture.

Aim of the study:

To determine the success rate of intracervical catheterization as a mode of induction of labour in case of intrauterine death (IUD) with previous history of caesarean section.

Methods:

This study was undertaken among the patients admitted in the Department of Obstetrics and Gyrtaecology, Dhaka Medical College Hospital during the period from January 2013 to December 2013. Intracervical catheterization were applied in 50 cases. All the pregnant women admitted and diagnosed as intrauterine fetal death with history of previous caesarean delivery.

Result:

In this study the mean age of the patients was 28.18±4.13 years. It was observed that nearly a half of patients (40%) belonged to 31-33 weeks of gestation, 34% between 33-37 weeks and 26% between 38-42 weeks. The common causes of IUD were idiopathic (60%) and gestational hypertension/pre-eclampsia/impending eclampsia as 20%. Other causes were hyper pyrexia (4%), congenital malformation (6%), postmaturity (6%), severe anaemia and Rh incompatibility (4%). Majority 42(84%) of the patients came from middle income group. Nearly half of the patients (44%) had no antenatal check up, 34% had irregular antenatal checkup and 22% had regular antenatal checkup during their pregnancy period. It was found that majority (94%) had achieving vaginal delivery and 6% were delivered by repeat LSCS. It was observed that the induction delivery interval varied from 16 to 23 hours 84% delivered within 20 hours and 16% delivered >20 hours. The mean induction to delivery interval was 11.8 hours. There were no major complications but only minor systemic side effects namely: nausea, shivering, vomiting, fever were observed in majority of the cases. A small number of cases developed reduced platelet count and post-partum haemorrhage and 2 patients developed chorioamnionitis.

Conclusion:

This study shows intracervicxal catheterization achieved successful induction of labour in women with intrauterine fetal death (IUFD) with previous caesarean delivery and shorten the time of induction delivery interval and significantly less side effects.