High rate of caesarean section in cases of intrauterine fetal demise in a low resource setting: Why?

Background: Stillbirth as an obstetric complication is emotionally devastating for the women as well as the clinician and having a caesarean section for stillbirth is even more catastrophic. The aim of the present research was to study the indications of caesarean section in women with intrauterine fetal demise in a low resource setting.Methods: This was an observational study for assessing the indication of caesarean section among 222/ 550 stillbirths from June 2013 to May 2014 in a tertiary care teaching hospital of North India. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. Details of women with intrauterine fetal demise in which caesarian section was done were noted and analyzed.Results: Out of 550 stillbirths, 222 women underwent caesarean section. Rate of caesarean section among women with stillbirth was 40.36%. Placenta previa (23.87%), Rupture uterus (22.1%), obstructed labour (10.8%), transverse lie (9.45%), failed induction (7.20%), massive abruption (5.86%), non-progress of labour (5.40%), eclampsia/pre-eclampsia related causes (4.95%), acute fetal distress (4.95%), were leading indications of caesarean sections. Out of 222 women, 162 (73%) women had anaemia (Hb <11g%). Severe anaemia (haemoglobin less then 7gm/dl) was present in 51 cases (23%).Conclusions: Caesarean section done for intrauterine death in present study were mostly inevitable. Reducing intrapartum stillbirths by improving essential obstetric services will ultimately result in reducing caesarean section rates in stillbirths in developing countries. Further studies are needed both in developing and developed countries to strategize the management of intrauterine dead fetus to prevent such high rate of caesarean section