231-POS

Abstract

Objectives Patients with hypertensive pregnancies are regarded to be susceptible for placental abruption (PA). Emergency cesarean section is preferred when the fetus is alive, but the mode of delivery after intrauterine fetal death (IUFD) is still controversial. We experienced a case of a patient with a hypertensive pregnancy that had a vaginal birth after IUFD by PA; she had cesarean section after recurrent PA 2 years later. We compared a trial of vaginal birth for IUFD fetus by PA (2011 onward) with immediate cesarean section (historical controls, performed before 2010). Methods Nine cases of vaginal birth trial after IUFD by PA were compared with eleven cases of immediate cesarean section as a historical case control study from review of medical records. Maternal age, gestational age, parity, course of delivery including time to deliver, blood loss or blood transfusion were compared statistically. Results One patient with a hypertensive pregnancy (superimposed preeclampsia) and IUFD after PA completed vaginal birth with little complications; she encountered recurrent PA 2 years later. In the second pregnancy, the fetus was survived so immediate cesarean section under general anesthesia was performed resulting in a liveborn baby. Eight of 9 trials of vaginal birth were completed successfully after IUFD by PA; however, one case failed to progress and cesarean section was needed. Maternal age, parity, blood loss or amount of blood transfusion showed no significant difference between two groups. The duration of hospital stay was significantly shorter in vaginal birth group compared to cesarean section group (P Conclusions Vaginal birth after IUFD by PA showed no inferiority against immediate cesarean section. However, one case of hypertensive pregnancy had recurrent PA. Strict reproductive and psychological follow-up is also required for patients who experience IUFD. Disclosures K. Nakano: None. K. Iwai: None. Y. Yamada: None. J. Akasaka: None. A. Shigemitsu: None. S. Onishi: None. K. Naruse: None. H. Kobayashi: None.