Management of stillbirths: an observational analysis at a rural tertiary care centre in Kerala, India


  • Ajini K. K. Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala, India
  • Reena R. P. Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala, India
  • Radha K. R. Department of Obstetrics and Gynecology, Government Medical College, Ernakulam, Kerala, India



Management of labour, Misoprostol, Previous caesarean, Stillbirths


Background: Stillbirth is a distressing event, both for the expecting mother and the obstetrician. Several maternal, social and circumstantial factors influence its occurrence. These women with intrauterine fetal death need to be treated in a considerate manner. Our aim was to analyse different methods   of induction, management of labour and their outcomes in women with antepartum fetal demise.

Methods: All women admitted to a tertiary care centre with intrauterine fetal death after 22 weeks during the study period of 24 months were recruited. Maternal sociodemographic characteristics and relevant investigations were studied. Induction of labour was achieved with mechanical and pharmacological methods.  Stillborn babies, placentae and umbilical cord were examined after delivery.

Results: There were 175 women with IUFD   admitted during the study period. The stillbirth rate was 38.6 per1000 live births.148 women (84.57%) required induction of labour while16 women had spontaneous onset of labour. Among the 44 women with previous Cesarean section, 11 underwent elective Cesarean section. 19 women (57.6%) out of 33 cases of trial of labour after Cesarean had a successful vaginal delivery. There were 2 cases of rupture uterus and 10 women required ICU admissions. Intrauterine growth restriction was the leading cause of stillbirth (41.8%) followed by hypertensive disorders (27.7%).

Conclusions: Present study has shown that vaginal birth can be achieved in most women with mechanical and pharmacological methods of induction within a reasonable period of time.


Blencowe H, Cousens S, Jassir FB, Say L, Cou D, Mathers C et al. National, regional and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Global Health. 2016;4(2):98-108.

Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA. 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Preg Childbirth. 2009;9(1):S2.

The Brighton Collaboration Stillbirth Working Group 2015. Available at: http://www.brighton

Gynecologists RC. Late intrauterine fetal death and stillbirth. Green-top Guideline. 2010;55:1-33.

National Institute for Health and Clinical Excellence. Clinical guideline no.70: Induction of labour. London: National Institute for Health and Clinical Excellence. 2008. Available at HTTP:// media/pdf CGO70NICE Guideline.pdf

Bugalho A, Bique C, Machungo F, Bergström S. Vaginal misoprostol as an alternative to oxytocin for induction of labor in women with late fetal death. Acta obstetricia et Gynecologica Scandinavica. 1995;74(3):194-8.

Chittacharoen A, Herabutya Y, Punyavachira P. A randomized trial of oral and vaginal misoprostol to manage delivery in cases of fetal death. Obstet Gynecol. 2003;101(1):70-3.

Nakintu N. A comparative study of vaginal misoprostol and intravenous oxytocin for induction of labour in women with intra uterine fetal death in Mulago Hospital, Uganda. Af Health Sci. 2001;1(2):55-9.

WHO recommendations for induction of labour. World health organization.2011. Available at /iris / bitstream / 10665 / 44531 / 1 / 9789241501156 - eng.pdf

Nzewi C, Araklitis G, Narvekar N. The use of mifepristone and misoprostol in the management of late intrauterine fetal death. Obstet Gynaecol. 2014;16(4):233-8.

Dickinson JE. Misporostol for second trimester termination in women with prior caesarean delivery. Obstet Gynecol.2005;105(2):352-6.

Vaginal birth after previous caesarean delivery: Clinical management guidelines for obstetricians and gynecologists. Obstet Gynecol.2004;104(1):203-212.

Midred M Ramirez, Sharon Gilbert. Mode of delivery in women with antepartum fetal death and prior cesarean delivery Am J Pernatol.2010; 27(10):825-30.

Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population-based cohort study. BMJ. 2005;331(7525):1113-7.






Original Research Articles