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Poster Session 3

Category: Clinical Obstetrics

Poster Session 3

(929) Mode of Delivery in United States stillborn pregnancies- a trend towards Cesarean delivery

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

RR

Ronald M. Ramus, MD

Professor
Virginia Commonwealth University
VCU Medical Center, Virginia, United States

Coauthor(s)

AV

Alison Verster, MD

Resident
Virginia Commonwealth University
Richmond, Virginia, United States
Joshua Brunton, DO (he/him/his)

MFM Fellow
Virginia Commonwealth University
Richmond, Virginia, United States
ES

Edward H. Springel, MD

Associate Professor
Virginia Commonwealth University
Richmond, Virginia, United States

Objective:
In the United States, the rate of Cesarean delivery (CD) has been increasing and is now the mode of delivery for over 30% of all pregnancies. Many of these Cesarean deliveries are performed for fetal indications, which is not a factor when delivering a stillborn fetus. The aim of this study was to determine if this trend is also seen amongst deliveries complicated by stillbirth. This analysis was conducted to understand current trends in stillbirth mode of delivery.

Study Design:
We conducted a retrospective cohort study using U.S. Vital Statistics Fetal Death data from 2014 to 2023. We included singleton births at >20 weeks' gestation with birthweight >300 grams that had data on mode of delivery. We determined the rate of CD for each year and used multivariate logistic regression to adjust for factors (maternal age, race, prior CD, gestational age, birthweight, hypertension, BMI, diabetes) that may contribute to the change in CD rates in this period.

Results:
Among the 167,891 participants that met study criteria, 139,728 delivered vaginally and 28,163 delivered via CD (rate of 16.8%). We noted a linear increase in crude CD rate for stillborn pregnancies over the period analyzed (p=0.001). In our unadjusted logistic model, CD was associated with increasing year (OR 1.015, 95% CI 1.01-1.02, p < 0.001) with an overall relative increase in CD of 11.8%. In the adjusted model, however, the year of delivery was not significant in predicting mode of delivery (p=0.424). Increasing maternal age, gestational age, birthweight, and BMI were each associated with higher odds of CD, as were race, prior CD, and maternal hypertension or diabetes in the adjusted model (p< 0.001).

Conclusion:
Though vaginal delivery remains the recommended mode of delivery for stillborn pregnancies, the rate of CD for stillborn pregnancies has increased over time. This analysis suggests changes in pregnancy demographics and obstetric complications over time provides a potential explanation for this increase. Further research is needed to determine clinical factors and practice patterns that are contributing to this trend.