Labor induction outcomes in third-trimester stillbirths.
OBJECTIVE
To describe the management of third-trimester stillbirth at a single institution, stratifying induction intervals and adverse outcomes by method.


METHODS
Women diagnosed with fetal demise at 28weeks or later and admitted to an academic hospital between January 2007 and September 2010 were identified. A chart review extracted demographics, history, induction method, delivery interval, and adverse outcomes.


RESULTS
Seventy-four women were included, with a median gestational age of 35.5weeks (range, 28-40weeks). Ten women had undergone at least 1 prior cesarean. Induction methods included misoprostol alone or for cervical ripening; oxytocin and amniotomy; transcervical Foley catheter; and mifepristone. Overall, 88% of patients delivered within 24hours; median time to fetal delivery was 11hours 20minutes (range, 7minutes to 57hours 12minutes). Adverse outcomes included intrapartum fever and postpartum hemorrhage. In total, 98% of patients, including those with prior cesarean, had a successful vaginal delivery.


CONCLUSIONS
Regardless of third-trimester induction method for management of stillbirth, the majority of women experience safe delivery within 24hours. The descriptive data imply that misoprostol-only inductions might confer the shortest induction intervals; however, further prospective trials are needed to identify the optimal misoprostol regimen for women with third-trimester stillbirth.
Department of Obstetrics and Gynecology, Section of Family Planning and Contraception, Northwestern University Feinberg School of Medicine, Chicago, USA. Electronic address: lgawron@northwestern.edu.
Lori M
LM
Gawron
Jessica W
JW
Kiley
D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000601:surgery; D020070:Cervical Ripening; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D015735:Mifepristone / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D050497:Stillbirth; D013997:Time Factors; D014546:Urinary Catheterization / Q000379:methods; D055815:Young Adult
D010120:Oxytocics; D016595:Misoprostol; D015735:Mifepristone; D010121:Oxytocin
Fetal demise; Induction; Misoprostol; Stillbirth; Third trimester