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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
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 2

Category: Obstetric Quality and Safety

Poster Session 2

(561) Severe maternal morbidity in second-stage Cesarean sections

Wednesday, February 11, 2026
3:30 PM - 5:00 PM  
Objective:
Second-stage Cesarean sections (CS), performed after full cervical dilation, are associated with higher maternal and neonatal morbidity compared to CS for other indications. Among patients undergoing 2nd-stage CS, we evaluated risk factors associated with severe maternal morbidity (SMM).

Study Design:
All nulliparous, term, singleton, vertex gestations delivered via CS in one health system between 2013-2024 were identified in electronic medical records (EMR). Second-stage CS was defined as cases with “full dilation” recorded.  Duration of the 2nd stage was calculated by subtracting the time of full dilation from the time of delivery; all outliers were reviewed. Patient demographics, comorbidities, and labor characteristics were obtained from the EMR. SMM cases were defined as those for which an SMM event per Centers for Disease Control criteria occurred after delivery but during the delivery admission. Bivariate, crude, and adjusted multivariate analyses were performed to assess the relationship between patient or labor characteristics and SMM among patients undergoing 2nd stage CS.

Results:

Of 2,680 total 2nd stage CS, 124 patients (4.6%) experienced SMM (Table 1). For reference, the SMM rate among all pregnancies in this system for the same period was 3.8%. Public insurance (aOR 1.86, 95% CI 1.20-2.87), anemia (aOR 1.86, 95% CI 1.20-2.87), and chronic kidney disease (aOR 12.70, 95% CI 4.75-33.97) was associated with increased odds of SMM, as were labor induction (aOR 1.76, 95% CI 1.18-2.61), chorioamnionitis (aOR 1.70, 95% CI 1.08-2.70), and intravenous magnesium (aOR 2.48, 95% CI 1.10-5.61) (Table 2). The duration of the 2nd stage of labor was ≥ 4 hours for most patients (65.3% of those without SMM; 62.2% of those with SMM), and not statistically associated with SMM.

Conclusion:
In patients undergoing 2nd stage CS, intrapartum events including labor induction, chorioamnionitis, and intravenous magnesium were associated with increased odds of SMM, while most pre-existing patient characteristics were not. Duration of the 2nd stage ≥ 4 hours was not associated with increased odds of SMM.