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Published on: June 6, 2020
Labor induction outcomes in third-trimester stillbirths
Lori M Gawron1, Jessica W Kiley
1Department of Obstetrics and Gynecology, Section of Family Planning and Contraception, Northwestern University Feinberg School of Medicine, Chicago, USA.
Summary
Management of third-trimester stillbirth is safe and effective, with most women delivering vaginally within 24 hours, regardless of induction method. Misoprostol may offer the shortest induction intervals for stillbirth management.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Reproductive Health
Background:
- Third-trimester stillbirth presents significant challenges in obstetric management.
- Induction of labor is a common approach for managing third-trimester stillbirth.
- Understanding delivery intervals and adverse outcomes associated with different induction methods is crucial.
Purpose of the Study:
- To describe the management of third-trimester stillbirth at a single institution.
- To stratify induction intervals and adverse outcomes by method used for stillbirth induction.
- To evaluate the safety and efficacy of various induction methods in stillbirth cases.
Main Methods:
- Retrospective chart review of women with fetal demise at or after 28 weeks gestation.
- Inclusion criteria: admission to an academic hospital between January 2007 and September 2010.
- Data collected: demographics, induction method, delivery interval, and adverse outcomes.
Main Results:
- Seventy-four women were included, with a median gestational age of 35.5 weeks.
- Induction methods: misoprostol, oxytocin/amniotomy, Foley catheter, mifepristone.
- 88% delivered within 24 hours; median delivery time was 11 hours 20 minutes. 98% achieved vaginal delivery, including those with prior cesarean.
- Adverse outcomes included intrapartum fever and postpartum hemorrhage.
Conclusions:
- Most women with third-trimester stillbirth deliver safely within 24 hours, irrespective of the induction method.
- Misoprostol-only inductions may be associated with shorter induction intervals.
- Further prospective trials are needed to optimize misoprostol regimens for third-trimester stillbirth management.
