Original Article

Cesarean Delivery Management of Stillbirth: In-Depth Analysis of 75 Cases in a Rural State

Authors: Abigail M. Ramseyer, DO, Julie R. Whittington, MD, Everett F. Magann, MD, Songthip Ounpraseuth, PhD, Wendy N. Nembhard, PhD

Abstract

Objective: To analyze the characteristics surrounding women who underwent cesarean delivery for stillbirth management in the rural, southern US state of Arkansas.

Methods: This was a planned secondary analysis of a retrospective descriptive study evaluating mode of delivery following the stillbirth of singleton pregnancies without anomalies or aneuploidy delivered in our state between July 2015 and June 2019. Data were extracted from a statewide reproductive health monitoring system and reviewed by the first three authors. Summary statistics were presented as means and standard deviations for continuous measures and frequencies and percentages for categorical variables.

Results: There were 861 patients diagnosed as having stillbirth between July 2015 and June 2019 in 44 hospitals in Arkansas. Seventy-five of those patients (8.7%) underwent cesarean delivery and are the basis for this analysis. Common indications for cesarean delivery were prior cesarean delivery (41%), malpresentation (18.7%), and abruption or hemorrhage (13.1%). Sixty-five percent of patients had a prior cesarean delivery. The most common complications were infection and hemorrhage, which accounted for 64.3% of known complications. The overall complication rate was 18.7% among stillbirths delivered via cesarean.

Conclusions: This study demonstrates that cesarean delivery remains a common mode of delivery for management of stillbirth and that there is maternal morbidity associated with an abdominal delivery because 22.7% of the women undergoing a cesarean had an operative complication. It also highlights that prior cesarean delivery remains a common indication for a repeat abdominal delivery following a stillbirth despite the lack of fetal benefit.
Posted in: Pregnancy32

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. American College of Obstetricians and Gynecologists. Management of stillbirth: Obstetric Care Consensus No. 10. Obstet Gynecol 2020;135:e110–e132.
 
2. Chakhtoura NA, Reddy UM. Management of stillbirth delivery. Semin Perinatol 2015;39:501–504.
 
3. Stefano VD, Santolaya-Forgas J, Faro R, et al. Mode of delivery in stillbirth, 1995-2004. Reprod Sci 2016;23:92–97.
 
4. An Act to Amend the Vital Statistics Act: Act 1254 of 1995 (Ark 1995). https://www.sos.arkansas.gov/uploads/rulesRegs/Arkansas%20Register/2016/feb2016/007.12.15-001.pdf. Accessed April 25, 2021.
 
5. 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;27:825–830.
 
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;129:693–698.
 
7. External Cephalic Version: ACOG Practice Bulletin, Number 221. Obstet Gynecol May 2020;135(5):e203–e212. doi:10.1097/aog.0000000000003837.
 
8. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 745: mode of term singleton breech delivery. Obstet Gynecol 2018;132:e60–e63.
 
9. Caughey AB, Cahill AG, Guise JM, et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014;210:179–193.
 
10. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011;205:262.e1–e8.
 
11. Roy A, Peaceman A, Son M, et al. Maternal obstetric complication rates remain high in Illinois: a retrospective study, 2010-2015. Jt Comm J Qual Patient Saf 2019;45:24–30.
 
12. Asch DA, Nicholson S, Srinivas S, et al. Evaluating obstetrical residency programs using patient outcomes. JAMA 2009;302:1277–1283.