evidence: Discussion on the mode of delivery depends on the gestational age of the stillborn, the patient's desires, physical status, and prior obstetrical/surgical history. Information is presented clearly and concisely, and confirmation of understanding should be obtained. Coagulation abnormalities caused by a release of tissue factor from the placenta may occur if the dead fetus is retained for several weeks.[104] The risk is about 2%, and this diagnosis requires immediate intervention.[105] In the absence of disseminated intravascular coagulation, infection, or preeclampsia with severe features, the mother/couple may go home and follow up to plan management. If expectant management is desired, spontaneous labor usually begins within 2 weeks of fetal death. Usually, a vaginal delivery is the safest route of delivery, even after a previous lower-segment cesarean delivery. Some women may request a primary or a repeat cesarean section to avoid experiencing labor. This is an option provided the patient is fully aware of the risks versus benefits. Stillbirth before 24 weeks is best managed by a dilation and evacuation (D & E) by a competent provider. This involves dilation of the cervix and manual removal of the product of conception.