Skip to main content
SMFM 2026 Pregnancy Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared outside of the session
Faculty have requested this content not be shared outside of the session
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
Poster Icons
Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Obstetric Quality and Safety

Poster Session 4

(1086) Beyond the Cesarean Rate: A Provider-Level Composite Metric for Perinatal Quality Assessment

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
To evaluate obstetrician-level variation using a unified composite outcome, complication-free vaginal delivery (CFVD), defined as vaginal delivery without maternal or neonatal complications, compare CFVD-based to cesarean delivery (CD)-based rankings, and assess correlations among CD, maternal, and neonatal complication rates among nulliparous, term, singleton, vertex (NTSV) births.

Study Design:

This retrospective cross-sectional study included all NTSV deliveries by obstetricians with ≥50 deliveries across 7 hospitals from January 2019 to December 2024. Maternal and neonatal complications were defined using Joint Commission criteria. For each provider, CFVD and CD rates were calculated, and rankings compared.

Results:

Among 55,841 NTSV deliveries, 233 obstetricians met inclusion. Rankings based on CFVD showed that 108 of 233 (46.4%) shifted by >10 ranks compared to CD-based rankings (Kendall Tau = 0.836, P < .0001). Correlations showed a weak negative association between CD and neonatal complication rates (r = −0.14, P = 0.04), a weak positive correlation between CD and maternal complications (r = 0.14, P = 0.03), and a weak positive correlation between maternal and neonatal complications (r = 0.14, P = 0.03).

Conclusion:

The current approach of emphasizing lowering the cesarean delivery rate, fails to account for maternal and neonatal complications and treats their outcomes independently, despite clinical interdependence. This may lead to misleading assessments of provider performance. Provider-level assessment using a composite dyadic outcome offers a more complete view of perinatal quality. Incorporating CFVD into quality metrics may improve benchmarking and better reflect patient-centered care.