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
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In singleton antepartum stillbirths, 18.9% underwent cesarean delivery.
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Rate of vaginal delivery was high when labor was attempted.
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Both clinical and non-clinical factors were associated with risk of cesarean delivery.
Keywords
stillbirth - mode of delivery - prior cesarean - labor
