Route of Delivery in Women With Stillbirth: Results From the Stillbirth Collaborative Research Network.
To describe delivery management of singleton stillbirths in a population-based, multicenter case series.



We conducted a retrospective chart review of 611 women with singleton stillbirths at 20 weeks of gestation or greater from March 2006 to September 2008. Medical and delivery information was abstracted from medical records. Both antepartum and intrapartum stillbirths were included; these were analyzed both together and separately. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery. Indications for cesarean delivery were classified as obstetric (abnormal fetal heart tracing before intrapartum demise, abruption, coagulopathy, uterine rupture, placenta previa, or labor dystocia) or nonobstetric (patient request, repeat cesarean delivery, or not documented).



Of the 611 total cases of stillbirth, 93 (15.2%) underwent cesarean delivery, including 43.0% (46/107) of women with prior cesarean delivery and 9.3% (47/504) of women without prior cesarean delivery. No documented obstetric indication was evident for 38.3% (18/47) of primary and 78.3% (36/46) of repeat cesarean deliveries. Labor induction resulted in vaginal delivery for 98.5% (321/326) of women without prior cesarean delivery and 91.1% (41/45) of women with a history of prior cesarean delivery, including two women who had uterine rupture. Among women with a history of prior cesarean delivery who had spontaneous labor, 74.1% (20/27) delivered vaginally, with no cases of uterine rupture.



Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery. However, 15% underwent cesarean delivery, often without a documented obstetric indication.
Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia; the Schools of Medicine and Public Health, Emory University, Atlanta, Georgia; the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York; the Department of Pediatrics and Dean's Office, UTHealth McGovern Medical School, Houston, Texas; the Department of Obstetrics and Gynecology, University of Texas School of Medicine-San Antonio, San Antonio, Texas; the Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; and the Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, Texas.
Annelee
A
Boyle
Jessica P
JP
Preslar
Carol J R
CJ
Hogue
Robert M
RM
Silver
Uma M
UM
Reddy
Robert L
RL
Goldenberg
Barbara J
BJ
Stoll
Michael W
MW
Varner
Deborah L
DL
Conway
George R
GR
Saade
Radek
R
Bukowski
Donald J
DJ
Dudley
D000328:Adult; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D003710:Demography; D004420:Dystocia / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014597:Uterine Rupture / Q000209:etiology / Q000601:surgery*