743 Mode of delivery in singleton stillbirths and associated risk factors

Abstract

There are limited data to inform management of delivery for women with stillbirth. This study aims to examine mode of delivery among stillbirth pregnancies and to identify factors that influence the risk of cesarean delivery. We used the California Linked Birth File to identify singleton stillbirths delivered at 20-42 weeks gestation between 2007 and 2011. Mode of delivery and maternal characteristics were determined based on linked data from fetal death records and diagnosis/procedure codes in maternal hospital discharge records. The associations between various maternal characteristics and the likelihood of cesarean delivery were analyzed using univariate as well as multivariable logistic regression. Of the total sample of 9,554 stillbirths, 3,933 (41.2%) underwent induction of labor, 4,201 (44.0%) entered spontaneous labor, and 1,420 (14.9%) had a planned cesarean delivery. Among women who were induced, 95.9% delivered vaginally. In the overall sample, 1,756 women (18.4%) were delivered via cesarean. Of these, 959 (54.6%) had a prior cesarean delivery, 467 (26.6%) had malpresentation, 310 (17.7%) had a failed trial of labor, and 82 (4.7%) had placenta previa. Among 841 women who had a trial of labor after cesarean (TOLAC), 734 (87.3%) delivered vaginally. In multivariable logistic regression, performance of cesarean delivery was associated with previous cesarean, nulliparity, term gestation, higher body mass index, placenta previa, malpresentation, and hypertensive disorder (Table 1). One in every six women with a stillbirth underwent cesarean delivery and almost half of these were primary cesarean deliveries. The most common reasons for cesarean delivery were prior cesarean and malpresentation. Induction of labor and TOLAC were associated with high success rates of vaginal delivery.