Management of Intrauterine Fetal Demise Cases: A Retrospective Analysis

Öz

Aim: To evaluate the management process and short-term maternal outcomes of pregnant women treated for intrauterine fetal demise (IUFD) at our institution, and to compare maternal outcomes according to the mode of delivery. Methods: In this single-center, retrospective, observational study, 115 cases at ≥20 weeks of gestation with absent fetal cardiac activity on ultrasonography (US) whose management was completed at the same center were analyzed. Demographic/obstetric characteristics and maternal morbidity outcomes (postpartum curettage, blood transfusion, additional interventions due to postpartum hemorrhage, intensive care unit [ICU] admission) were assessed, and surgical procedures performed for various indications were described. Multivariable logistic regression models were constructed to identify factors associated with cesarean delivery and severe maternal morbidity. Results: The mean maternal age was 31.0±6.9 years, and the median gestational age was 32.5 (27.1–35.5) weeks. Induction of labor was performed in 55.7% of cases (most commonly misoprostol, 37.4%). Deliveries occurred vaginally in 74.8%. The median time from admission to delivery was 4.5 (1.4–15.3) hours, and the median length of hospital stay was 2.0 (2.0–3.5) days. Placental pathology examination was performed in 67.0% of cases, with abnormal findings identified in 60.9%. Postpartum curettage was required in 37.4%, blood transfusion in 18.3%, ICU admission in 8.7%, and severe maternal morbidity occurred in 20.0%. Compared with the vaginal delivery group, the cesarean group had a greater hemoglobin decrease, higher transfusion requirement, and more frequent ICU admission (p<0.001, p=0.004, and p<0.001, respectively). Increasing gestational age was associated with a higher likelihood of cesarean delivery (adjusted odds ratio [aOR] 1.15; p=0.015). Cesarean delivery was independently associated with severe maternal morbidity (aOR 5.14; 95% CI 1.84–14.38; p=0.002). Conclusions: While most IUFD cases can be managed with vaginal delivery, cesarean delivery—when required—is associated with increased blood loss and higher transfusion/ICU needs. A history of prior cesarean delivery and advanced gestational age increase the probability of cesarean delivery, and cesarean delivery is an independent predictor of severe maternal morbidity. These findings support the need to standardize decision-making in IUFD management with a primary focus on maternal safety.

Anahtar Kelimeler

• intrauterine fetal demise
• stillbirth
• labor induction
• misoprostol
• cesarean delivery
• maternal morbidity
• placental pathology

İntrauterin Fetal Ölüm Vakalarının Yönetimi: Retrospektif Bir Analiz

Öz

Amaç: İntrauterin fetal ölüm (İUFO) tanısı ile hastanemizde tedavi edilen gebelerin yönetim sürecini ve kısa dönem maternal sonuçlarını değerlendirmek. Ayrıca doğum şekline göre maternal sonuçları karşılaştırmak. Materyal Method: Tek merkezli, retrospektif, gözlemsel çalışmada 20. gebelik haftası ve üzerindeki, ultrasonografide (USG) fetal kalp atımı izlenmeyen ve yönetimi aynı merkezde tamamlanan 115 olgu değerlendirildi. Demografik/obstetrik özellikler ve maternal morbidite ile ilgili sonuçları (PP küretaj, transfüzyon, PPH nedeniyle ek girişim, YBÜ yatışı) incelendi, çeşitli endikasyonlar ile yapılan cerrahi girişimler tanımlandı. Sezaryen ile sonlanma ve şiddetli maternal morbidite için çok değişkenli lojistik regresyon kuruldu. Bulgular: Ortalama yaş 31.0±6.9 yıl, median gebelik haftası 32.5 (27.1–35.5) hafta idi. Olguların %55.7’sinde indüksiyon uygulandı (en sık misoprostol, %37.4). Doğumların %74.8’i vajinal, %25.2’si sezaryen ile gerçekleşti. Yatıştan doğuma kadar geçen median süre 4.5 (1.4–15.3) saat, hastanede kalış süresi ise 2.0 (2.0–3.5) gün idi. Plasenta patolojisi %67.0 incelemesi olguda yapıldı ve %60.9’unda anormal bulgu saptandı. PP küretaj %37.4, kan transfüzyon ihtiyacı %18.3, YBÜ yatışı %8.7 ve şiddetli maternal morbidite %20.0 oranında görüldü. Sezaryen grubunda Hb düşüşü, transfüzyon ihtiyacı ve YBÜ yatışı daha yüksekti (p<0.001; p=0.004; p<0.001). Gebelik haftası artışı sezaryen olasılığı ile ilişkiliydi (aOR:1.15; p:0.015). Şiddetli maternal morbidite bağımsız olarak sezaryen ile sonlanma ile ilişkili bulundu (aOR:5.14; %95 GA 1.84–14.38; p:0.002). Tartışma: İUFO olgularının çoğu vajinal doğum ile yönetilebilirken, sezaryen gereken olgularda artmış kan kaybı ve transfüzyon/YBÜ ihtiyacı ile ilişkilidir. Önceden sezaryen geçirmiş olma ve daha ileri gebelik haftası sezaryen olasılığını artırırken, sezaryen şiddetli maternal morbiditenin bağımsız belirleyicisidir. Bu bulgular, İUFO yönetiminde kararın öncelikle maternal güvenlik odağında standardize edilmesi gerektiğini desteklemektedir.

Anahtar Kelimeler

• intrauterin fetal ölüm
• ölü doğum
• doğum indüksiyonu
• misoprostol
• sezaryen
• maternal morbidite
• plasenta patolojisi

Kaynakça

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