Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study

Abstract The effect of timing of hospital admission for stillbirth delivery following late intrauterine fetal death (IUFD) has not yet been described. By this study, we aimed to gain an understanding of the impact of “immediate” (i.e., on the same day of IUFD diagnosis) versus “delayed” hospital adm...

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Autores principales:	Dana Anaïs Muin, Anke Scharrer, Alex Farr, Herbert Kiss, Helmuth Haslacher
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e472cc13ca0c43aebfeb4cdbfc15769a
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spelling	oai:doaj.org-article:e472cc13ca0c43aebfeb4cdbfc15769a2021-12-02T17:26:55ZTiming of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study10.1038/s41598-021-98229-92045-2322https://doaj.org/article/e472cc13ca0c43aebfeb4cdbfc15769a2021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-98229-9https://doaj.org/toc/2045-2322Abstract The effect of timing of hospital admission for stillbirth delivery following late intrauterine fetal death (IUFD) has not yet been described. By this study, we aimed to gain an understanding of the impact of “immediate” (i.e., on the same day of IUFD diagnosis) versus “delayed” hospital admission (i.e., on the subsequent day or two days after IUFD diagnosis) on maternal and delivery outcome parameters. This retrospective cohort study comprised all women who suffered a singleton IUFD ≥ 21 gestational weeks and delivered the stillborn at our tertiary referral center between 2003 and 2019. We excluded all terminations of pregnancy and women presenting with acute symptoms on the day of IUFD diagnosis. In total, 183 women were included of whom 69.4% (n = 127) were immediately admitted and 30.6% (n = 56) had delayed admission. Median gestational age of IUFD was 30+3 (21+0–41+3) weeks. Whilst women with early signs of labor were more frequently admitted immediately (87.5%; 14/16), neither maternal demographic and obstetric parameters, nor day of the week or presenting symptoms influenced the timing of hospital admission. 77.6% (142/183) of women after IUFD diagnosis delivered within the first 3 days after admission. Women after immediate admission equally often delivered on admission day and the day after (26.0%; 33/127 each), women after delayed admission most commonly delivered the day after admission (39.3%; 22/56). Stillbirth delivery on the day of diagnosis was more common upon immediate admission (p = 0.006), especially in early gestational weeks (p = 0.003) and with small fetal weight (p < 0.001), requiring less induction of labor. No significant difference regarding delivery mode, labor duration, use of intrapartum analgesia, need for episiotomy and risk of perineal injury was observed between the groups. Also rate of intrapartum hemorrhage was independent of admission timing, although immediately admitted women experienced greater median blood loss after vaginal delivery. Maternal laboratory parameters (hemoglobin, thrombocytes and CRP) were independent of admission timing, except for higher levels of leucocytes, neutrophils and lymphocytes in immediately admitted women. Our study shows no clinical superiority of immediate hospital admission for stillbirth delivery. Under stable medical circumstances, it, therefore, seems feasible to allow the woman delayed admission for labor and delivery.Dana Anaïs MuinAnke ScharrerAlex FarrHerbert KissHelmuth HaslacherNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Dana Anaïs Muin Anke Scharrer Alex Farr Herbert Kiss Helmuth Haslacher Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study
description	Abstract The effect of timing of hospital admission for stillbirth delivery following late intrauterine fetal death (IUFD) has not yet been described. By this study, we aimed to gain an understanding of the impact of “immediate” (i.e., on the same day of IUFD diagnosis) versus “delayed” hospital admission (i.e., on the subsequent day or two days after IUFD diagnosis) on maternal and delivery outcome parameters. This retrospective cohort study comprised all women who suffered a singleton IUFD ≥ 21 gestational weeks and delivered the stillborn at our tertiary referral center between 2003 and 2019. We excluded all terminations of pregnancy and women presenting with acute symptoms on the day of IUFD diagnosis. In total, 183 women were included of whom 69.4% (n = 127) were immediately admitted and 30.6% (n = 56) had delayed admission. Median gestational age of IUFD was 30+3 (21+0–41+3) weeks. Whilst women with early signs of labor were more frequently admitted immediately (87.5%; 14/16), neither maternal demographic and obstetric parameters, nor day of the week or presenting symptoms influenced the timing of hospital admission. 77.6% (142/183) of women after IUFD diagnosis delivered within the first 3 days after admission. Women after immediate admission equally often delivered on admission day and the day after (26.0%; 33/127 each), women after delayed admission most commonly delivered the day after admission (39.3%; 22/56). Stillbirth delivery on the day of diagnosis was more common upon immediate admission (p = 0.006), especially in early gestational weeks (p = 0.003) and with small fetal weight (p < 0.001), requiring less induction of labor. No significant difference regarding delivery mode, labor duration, use of intrapartum analgesia, need for episiotomy and risk of perineal injury was observed between the groups. Also rate of intrapartum hemorrhage was independent of admission timing, although immediately admitted women experienced greater median blood loss after vaginal delivery. Maternal laboratory parameters (hemoglobin, thrombocytes and CRP) were independent of admission timing, except for higher levels of leucocytes, neutrophils and lymphocytes in immediately admitted women. Our study shows no clinical superiority of immediate hospital admission for stillbirth delivery. Under stable medical circumstances, it, therefore, seems feasible to allow the woman delayed admission for labor and delivery.
format	article
author	Dana Anaïs Muin Anke Scharrer Alex Farr Herbert Kiss Helmuth Haslacher
author_facet	Dana Anaïs Muin Anke Scharrer Alex Farr Herbert Kiss Helmuth Haslacher
author_sort	Dana Anaïs Muin
title	Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study
title_short	Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study
title_full	Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study
title_fullStr	Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study
title_full_unstemmed	Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study
title_sort	timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/e472cc13ca0c43aebfeb4cdbfc15769a
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Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study

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