Delivery modes in intrauterine fetal death

This study aimed to analyze the mode of delivery intrauterine death and analysis of factors that determine the choice. We analyzed 96 cases of intrauterine death in a singleton pregnancy during the 2016–2018. Two groups were formed: the 1st group (n = 32) of cesarean delivery, the 2nd group (n = 64) with vaginal delivery. The stillbirth rate for the region was 6.2% [95% CI 4.88–8.84], for the Russian Federation — 5.82% [95% CI 5.17–7.39]. The proportion of cesarean sections in intrauterine death is higher than in live births (33.3% and 31.8% respectively). When analyzing the timing of delivery, it was found that the characteristic peaks occur at 25–27 weeks (25.0% of all births) and 37–39 weeks (35.0%). Obstetric risk factors for cesarean section: placental abruption: OR — 9.64 [95% CI 3.25–28.63]; p = 0.000; uterine scar after cesarean section: OR — 7.51 [95% CI 2.52–22.39]; p = 0.000; preeclampsia: OR — 4.17 [95% CI 1.12–15.47]; p = 0.023. Non-obstetric risk factors: parity of 3 or more births: HR — 7.24 [95% CI 1.36–38.40]; p = 0.009; overweight: HR — 3.37 [95% CI 1.22–9.33]; p = 0.016; the history of the pelvic inflammatory disease: HR — 2.78 [95% CI 1.12–15.47]; p = 0.023. The presence of intrauterine growth retardation reduces the frequency of surgery: HR — 0.56 [95% CI 0.22–1.43]; p = 0.221. There is an urgent need to develop and implement in clinical practice appropriate national clinical guidelines for the management of childbirth with intrauterine death, including all aspects of this category of care. It is necessary to further study the role of the crisis stages of gestation, which are characterized by the manifestation of intrauterine death (the end of the second and third trimesters).