Purpose: To evaluate the efficacy of vaginal misoprostol for labor induction in intrauterine fetal death (IUFD) at ≥ 20 weeks’ gestation. Patients and Methods: This retrospective cohort study reviewed medical records of IUFD cases between 2021 and 2023 at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Women with IUFD at ≥ 20 weeks’ gestation who underwent vaginal misoprostol induction were included, and cases with incomplete key data were excluded. Outcomes included induction-to-contraction interval, induction-to-delivery interval, and cumulative misoprostol dose. Comparisons across gestational age groups (21– 27, 28– 36, and ≥ 37 weeks) were performed using the Kruskal–Wallis test; categorical variables were analyzed using the chi-square test. Results: Of 155 IUFD cases, 71 received misoprostol-only induction and were analyzed. Median induction-to-contraction intervals were 12 hours, 6 hours, and 3 hours in the 21– 27, 28– 36, and ≥ 37 weeks groups, respectively (p< 0.001). Median induction-to-delivery intervals were 13 hours, 10 hours, and 6 hours, respectively (p=0.010). Median cumulative misoprostol doses decreased significantly with advancing gestational age: 200 μg, 100 μg, and 50 μg, respectively (p< 0.001). Maternal age and parity did not differ significantly among groups. Conclusion: Vaginal misoprostol was associated with shorter induction intervals and lower cumulative dose requirements at later gestational ages in IUFD. Prospective multicenter studies are needed to confirm optimal regimens and safety. Keywords: labor induction interval, gestational age stratification, prostaglandin, induction dosing, stillbirth management
Flowerina et al. (Mon,) studied this question.
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