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Am J Perinatol 2024; 41(S 01): e193-e203
DOI: 10.1055/s-0042-1750795
Original Article

Mode of Delivery in Antepartum Singleton Stillbirths and Associated Risk Factors

Katherine Underwood
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Uma M. Reddy
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Hillary Hosier
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Lena Sweeney
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Katherine H. Campbell
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Xiao Xu
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
› Author Affiliations Funding This study was supported by the Albert McKern Scholar Award.
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Abstract

Objective This study was aimed to investigate delivery management of patients with antepartum stillbirth.

Study Design Using data from fetal death certificates and linked maternal hospital discharge records, we identified a population-based sample of patients with singleton antepartum stillbirth at 20 to 42 weeks of gestation in California in 2007 to 2011. Primary outcomes were intended mode of delivery and actual mode of delivery. We used multivariable regressions to examine the association between patient demographic, clinical, and hospital characteristics and their mode of delivery. Separate analysis was performed for patients who had prior cesarean delivery versus those who did not.

Results Of 7,813 patients with singleton antepartum stillbirth, 1,356 had prior cesarean, while 6,457 had no prior cesarean. Labor was attempted in 51.8% of patients with prior cesarean and 93.7% of patients without prior cesarean, with 76.2 and 95.8% of these patients, respectively, delivered vaginally. Overall, 18.9% of patients underwent a cesarean delivery (60.5% among those with prior cesarean and 10.2% among those without prior cesarean). Multivariable regression analysis identified several factors associated with the risk of cesarean delivery that were not medically indicated. For instance, among patients without prior cesarean, malpresentation (of which the vast majority was breech presentation) was associated with an increased likelihood of planned cesarean (adjusted odds ratio [OR] = 3.26, 95% confidence interval [CI]: 2.53–4.22) and cesarean delivery after attempting labor (adjusted OR = 3.09, 95% CI: 2.25–4.25). For both patients with and without prior cesarean, delivery at an urban teaching hospital was associated with a lower likelihood of planned cesarean and a lower likelihood of cesarean delivery after attempting labor (adjusted ORs ranged from 0.28 to 0.56, p < 0.001 for all).

Conclusion Over one in six patients with antepartum stillbirth underwent cesarean delivery. Among patients who attempted labor, rate of vaginal delivery was generally high, suggesting a potential opportunity to increase vaginal delivery in this population.

Key Points

  • In singleton antepartum stillbirths, 18.9% underwent cesarean delivery.

  • Rate of vaginal delivery was high when labor was attempted.

  • Both clinical and non-clinical factors were associated with risk of cesarean delivery.

Keywords

stillbirth - mode of delivery - prior cesarean - labor

Note

Preliminary findings of this study were presented at the Society for Maternal-Fetal Medicine's virtual Annual Pregnancy Meeting, January 25–30, 2021.




Publication History

Received: 27 April 2022

Accepted: 16 May 2022

Article published online:
18 July 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Center for Disease Control and Prevention/National Center for Health Statistics. Model state vital statistics act and regulations. Accessed June 1, 2022 at: https://www.cdc.gov/nchs/data/misc/mvsact92b.pdf
    PubMedGoogle Scholar
  • 2 Gregory EC, Valenzuela CP, Hoyert DL. Fetal mortality: United States, 2019. Natl Vital Stat Rep. 2021; 70 (11) 1-20
    PubMedGoogle Scholar
  • 3 MacDorman MF, Gregory ECW. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep. 2015; 64 (08) 1-24
    PubMedGoogle Scholar
  • 4 Royal College of Obstetricians and Gynaecologists. Late intrauterine fetal death and stillbirth (green-top guideline no. 55). Accessed December 22, 2021 at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_55.pdf
    PubMedGoogle Scholar
  • 5 Management of stillbirth: obstetric care consensus no, 10. Obstet Gynecol 2020; 135 (03) e110-e132
    CrossrefPubMedGoogle Scholar
  • 6 Boyle A, Preslar JP, Hogue CJ. et al. Route of delivery in women with stillbirth: results from the stillbirth collaborative research network. Obstet Gynecol 2017; 129 (04) 693-698
    CrossrefPubMedGoogle Scholar
  • 7 Rossi RM, Hall ES, DeFranco EA. Mode of delivery in antepartum stillbirths. Am J Obstet Gynecol MFM 2019; 1 (02) 156-164.e2
    CrossrefPubMedGoogle Scholar
  • 8 Stefano VD, Santolaya-Forgas J, Faro R, Duzyj C, Oyelese Y. Mode of delivery in stillbirth, 1995-2004. Reprod Sci 2016; 23 (01) 92-97
    CrossrefPubMedGoogle Scholar
  • 9 California Office of Statewide Health Planning and Development. Linked birth files Accessed November 26, 2021 at: https://hcai.ca.gov/data-and-reports/research-data-request-information/#linked-birth-files
    PubMedGoogle Scholar
  • 10 American Hospital Association. AHA Annual Survey Database. Accessed November 29, 2021 at: https://www.ahadata.com/aha-annual-survey-database
    PubMedGoogle Scholar
  • 11 Leonard SA, Kennedy CJ, Carmichael SL, Lyell DJ, Main EK. An expanded obstetric comorbidity scoring system for predicting severe maternal morbidity. Obstet Gynecol 2020; 136 (03) 440-449
    CrossrefPubMedGoogle Scholar
  • 12 Buinoiu NF, Stoica SI, Mat C, Panaitescu A, Peltecu G, Gica N. Mode of delivery in stillbirth. Maedica (Bucur) 2017; 12 (02) 101-105
    PubMedGoogle Scholar
  • 13 do Nascimento MI, Cunha AdeA, Oliveira SR. Clinical management of the induction of labor in intrauterine fetal death: evaluation of incidence of cesarean section and related conditions. Rev Bras Epidemiol 2014; 17 (01) 203-216
    CrossrefPubMedGoogle Scholar
  • 14 Gawron LM, Kiley JW. Labor induction outcomes in third-trimester stillbirths. Int J Gynaecol Obstet 2013; 123 (03) 203-206
    CrossrefPubMedGoogle Scholar
  • 15 Ramirez MM, Gilbert S, Landon MB. et al. Mode of delivery in women with antepartum fetal death and prior cesarean delivery. Am J Perinatol 2010; 27 (10) 825-830
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Ramseyer AM, Whittington JR, Magann EF, Warford B, Ounpraseuth S, Nembhard WN. Hospital annual delivery volume and presence of graduate medical education influence mode of delivery after stillbirth. South Med J 2020; 113 (12) 623-628
    CrossrefPubMedGoogle Scholar
  • 17 Ramseyer AM, Whittington JR, Magann EF, Ounpraseuth S, Nembhard WN. Cesarean delivery management of stillbirth: in-depth analysis of 75 cases in a rural state. South Med J 2021; 114 (07) 384-387
    CrossrefPubMedGoogle Scholar
  • 18 Walther F, Kuester D, Bieber A, Malzahn J, Rüdiger M, Schmitt J. Are birth outcomes in low risk birth cohorts related to hospital birth volumes? A systematic review. BMC Pregnancy Childbirth 2021; 21 (01) 531
    CrossrefPubMedGoogle Scholar
  • 19 Hemminki E, Heino A, Gissler M. Should births be centralised in higher level hospitals? Experiences from regionalised health care in Finland. BJOG 2011; 118 (10) 1186-1195
    CrossrefPubMedGoogle Scholar
  • 20 Tracy SK, Sullivan E, Dahlen H, Black D, Wang YA, Tracy MB. Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women. BJOG 2006; 113 (01) 86-96
    CrossrefPubMedGoogle Scholar
  • 21 Chakhtoura NA, Reddy UM. Management of stillbirth delivery. Semin Perinatol 2015; 39 (06) 501-504
    CrossrefPubMedGoogle Scholar
  • 22 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 205: vaginal birth after cesarean delivery. Obstet Gynecol 2019; 133 (02) e110-e127
    CrossrefPubMedGoogle Scholar