title: Clinical management of the induction of labor in intrauterine fetal death: evaluation of incidence of cesarean section and related conditions.
abstract: OBJECTIVE
  To assess the incidence and conditions associated with cesarean section in a cohort of pregnant women with intrauterine fetal death (IUFD), and clinical management to anticipate the childbirth.
  
  
  METHODS
  It was a retrospective cohort study with 163 mothers with IUFD, at the second half of pregnancy, who were managed to anticipate childbirth using pharmacological preparations and/or a mechanical method (Foley catheter) in a teaching hospital in Rio de Janeiro State, Brazil. Cox regression was used to evaluate the effect of the clinical methods on the kind of delivery.
  
  
  RESULTS
  The Subgroups A (misoprostol or Oxytocin), B (misoprostol and Oxytocin), and C (Foley catheter alone or combined with misoprostol and/or Oxytocin) were formed according to the applied methods. Nine out of 163 cases ended with cesarean section. The incidence of cesarean section was 3.5 per 1,000 people-hours, meaning that a pregnant woman with IUFD had a 15.6% risk of cesarean section during the first 48 hours of clinical management to anticipate childbirth. The conditions significantly associated with the mode of delivery were placental abruption (HR: 44.97), having two or more previous cesarean deliveries (HR: 10.03), and mechanical method with Foley catheter (HR: 5.01).
  
  
  CONCLUSIONS
  Cesarean section was an essential conduct in this cohort and followed previous cesarean delivery and placental abruption. The effect of the mechanical method on the abdominal route suggests that the Foley catheter method was used in the most difficult cases and that the surgery was performed to ensure maternal health.
authors.affiliation: Departamento de Epidemiologia e Bioestatística, Universidade Federal Fluminense, Niterói, RJ, Brasil.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: do Nascimento
authors.affiliation: Departamento de Ginecologia e Obstetrícia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Alfredo de Almeida
authors.initials: Ade A
authors.lastname: Cunha
authors.affiliation: Coordenação da Clínica de Obstetrícia, Hospital Geral de Nova Iguaçu, Nova Iguaçu, RJ, Brasil.
authors.forename: Sandra Regina dos Santos Muri
authors.initials: SR
authors.lastname: Oliveira
mesh_terms: D000028:Abortion, Induced / Q000295:instrumentation; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D006801:Humans; D016595:Misoprostol; D010120:Oxytocics; D010121:Oxytocin; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin