Expectant Management Versus Induction of Labour for Intrauterine Fetal Death

Abstract

Objective: To compare the delivery outcome of patients managed with induction of labour versus spontaneous onset of labour following intrauterine fetal death.
Methods: Women who had an intrauterine fetal death from 1 January 2000 to 31 December 2015 in a regional hospital in Hong Kong were analysed to compare their delivery outcome following expectant management for spontaneous onset or induction of labour. The outcomes studied included the duration of labour, rate of infection, rate of coagulopathy, psychological stress, and other morbidities.
Results: A total of 193 patients fulfilled the inclusion criteria of whom 116 underwent labour induction and 51 elected spontaneous onset of labour; 26 patients were excluded from the analysis because 12 were already in active labour on admission, 13 changed their decision during the process, and one opted for Caesarean section. Patients with more advanced gestational age (p=0.004) and larger cervical dilatation (p<0.001) were more likely to opt for expectant
management. The expectant group had a significantly shorter hospitalisation stay (4.8 days vs. 6.3 days; p<0.001) and shorter time from admission to delivery (4.6 days vs. 5.2 days; p=0.002) than the induction group. On the other hand, the induction group had a significantly shorter first stage of labour (4:05 hours vs. 4:52 hours; p=0.033) and less total blood loss (133.9 ml vs. 169.0 ml; p=0.013). Two cases in the induction group required emergency Caesarean section. There were no significant differences in the rate of infection, coagulopathy, or postnatal depression.
Conclusion: Both expectant management and induction of labour were safe options for intrauterine fetal death. Patients should be managed according to their preference and clinical condition.