Introduction: The choice of the mode of delivery, in case of stillbirth
(SB) (fetus non-viable 22 weeks’ gestation), should consider maternal
preference, gestational age, bishop score, the clinical condition of the woman,
and her previous obstetric history. However, despite these clear indications,
data on the effective implementation of the latter are lacking. The aim of our
study is to evaluate the different modes of delivery in an Italian population of
SBs, according to gestational age, parity, causes of death, obstetric history,
and maternal characteristics. Material and Methods: This is an
area-based, prospective cohort study conducted in Emilia Romagna, Italy between
January 2014 to December 2020. Data included all cases of SB (22 weeks).
Results: From 2014 to 2020, 783 SB occurred out of a total of 232.506
births, with a SB rate of 3.3 per 1000. Labor was spontaneous in 85 (11%). Of
remnant, 567 (73.6%) were induced and 118 (15.3%) had no labor. The mode of
delivery was vaginal in most of the cases (649/770, 84.3%) and by cesarean
section in 121/770 (15.7%) of cases. Emergency CS was most frequent and
performed in 89/121 (73.5%) of total CS, representing 11.5% of SB deliveries.
Mode of induction did not differ in relation to gestational age at stillbirth,
while vaginal delivery was significantly higher in women induced with
prostaglandins (p = 0.000) respect to other methods. Nulliparous women
had a significantly higher need for multiple methods of induction (p =
0.000) respect multiparous and obese women used more frequently prostaglandins
(p = 0.03) than other methods. Women with a history of previous CS
presented a significantly higher rate of repeated elective CS (p =
0.000). Moreover, emergency CS was performed more frequent in obese (p =
0.02), diabetic (p = 0.04) and hypertensive (p = 0.04) women
and in SB caused by placenta disorders, namely in abruptio placentae (p
= 0.000). In the case of chorioamnionitis and funisitis women significantly were
induced with prostaglandin (p = 0.000) and delivered vaginally
(p = 0.000). Conclusions: The method of induction of labor and
the mode of delivery in case of SB did not depend on gestational age at the
diagnosis of death, while they are related to placenta disorders representing a
relevant condition leading to emergency CS also after diagnosis of fetal death.
These data could help obstetric providers in managing the deliveries of stillborn
infants.