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CME Credit Offered
CME Credit Offered
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Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
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AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 2

Category: Epidemiology

Poster Session 2

(479) Can the Expanded Obstetric Co-morbidity Score predict Intrapartum SMM using data available during prenatal care?

Wednesday, February 11, 2026
3:30 PM - 5:00 PM  
Objective:
The Expanded Obstetric Comorbidity Score (EOCS) utilizes preexisting medical and obstetric conditions to predict severe maternal morbidity (SMM). We assessed whether a modified EOCS of co-morbidities limited to those available at mid-gestation could predict the incidence of SMM at delivery, a prediction that could drive consultations to improve pregnancy outcomes, particularly in low volume and rural settings.

Study Design:
Linked maternal discharge and vital record data for live- and stillbirths (≥20 weeks) from OR, SC (2008-2020) and PA (2008-2018) were analyzed. Modified EOCS was calculated excluding preterm birth, preeclampsia, and abruption. Co-morbidities and SMM (total and non-transfusion) were calculated using ICD codes. Modified Poisson regression modelling was used predict SMM rates based on the EOCS, unadjusted and adjusted for age and parity. Established urban-rural and hospital volume classifications were utilized. Standard NICU levels were used in lieu of maternal levels of care.

Results:
1,731,858 records were examined. The population mean for total SMM was 1.4%. Natural cut-points were observed dividing the population into 5 groups. 79.2% of the population were in the first group (scores of 0-5) and had a baseline SMM rate of 0.7%. The 3rd to 5th groups with scores of 17-24, 25-36, and 37-76 points had adjusted RR for intrapartum SMM of 8.3, 22.3 and 66.0 (Fig 1). Adjustment for maternal age and parity did not alter the results. Similar findings were noted for non-transfusion SMM. While the majority of the higher risk groups delivered at Level 3 and 4 hospitals, substantial numbers still delivered in Level 1 and 2 and in rural and low-volume urban hospitals (Table 1).

Conclusion:
The EOCS could identify prenatal patients at much greater risk for intrapartum SMM within a small percentage of the population. Use of the score could move risk appropriate care to the prenatal period allowing for optimization of care before intrapartum admission. This could be of particular value for obstetric care in small and rural hospitals.