Tural ISMAYILOV, Nebahat UZUNAY, Zeynep Yavaş YÜCEL
Çukurova Anestezi ve Cerrahi Bilimler Dergisi - 2026;9(3):695-705
Background: To evaluate the management process and short-term maternal outcomes of women managed for intrauterine fetal demise (IUFD) and to compare maternal outcomes according to the mode of delivery. Materials and Methods: This single-center, retrospective, observational study included 115 women at >=20 weeks of gestation with absent fetal cardiac activity on ultrasonography whose management was completed at the same institution. Demographic and obstetric characteristics, delivery-related variables, and maternal morbidity outcomes were evaluated. Multivariable logistic regression analyses were performed 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. Labor induction was performed in 55.7% of cases, most commonly with misoprostol (37.4%). Vaginal delivery occurred in 74.8% of women. The median admission-to-delivery interval was 4.5 (1.4 -15.3) hours. Placental pathological examination was performed in 67.0% of cases, with abnormal findings identified in 94.8%. Postpartum curettage was required in 37.4% of cases, blood transfusion in 18.3%, ICU admission in 8.7%, and severe maternal morbidity occurred in 20.0%. Compared with vaginal delivery, cesarean delivery was associated with greater hemoglobin decline, higher transfusion requirement, and more frequent ICU admission. Increasing gestational age was associated with cesarean delivery (aOR 1.15; p=0.015), whereas cesarean delivery was independently associated with severe maternal morbidity (aOR 5.14; 95% CI 1.84-14.38; p=0.002). Conclusion: Most women with IUFD can be managed successfully with vaginal delivery. Cesarean delivery, when required, is associated with increased maternal morbidity. Clinical decision-making in IUFD should prioritize maternal safety and support the use of standardized management strategies.
