(796) Impact of fetal head station on maternal and neonatal outcomes in second-stage cesarean delivery

A retrospective cohort study of term pregnant women who underwent cesarean delivery at full cervical dilatation was assessed for adverse maternal and neonatal outcomes. The study was conducted in a tertiary medical center between 2012-2023. Patients were categorized based on fetal head station in a manual examination: at or above ischial spines and below ischial spines. Maternal outcomes analyzed included cesarean section duration, need for push assistance, uterine extension, postpartum fever, hemoglobin drop, postpartum hemorrhage, blood transfusion, puerperal endometritis, and rehospitalization. Neonatal outcomes evaluated were 5-minute APGAR scores, arterial pH levels, and NICU admissions.

Results: Of the 418 patients studied, fetal head station was at or above ischial spines in 276 patients and below spines in 142 patients. The below ischial spines group had a higher incidence of failed vacuum attempts (50.7% vs. 13.0%, P< 0.001) and required more blood transfusions (16.2% vs. 7.6%, P=0.011). Additionally, neonatal arterial pH levels < 7.2 were significantly more common in the below ischial spines group (21.8% vs. 13.0%, P=0.013). The composite neonatal outcomes were more common in the below ischial spines group (16.9% vs. 9.8%, P=0.041, Table 1). However, in a subgroup analysis excluding cases with failed vacuum attempts, no significant differences in maternal and neonatal adverse outcomes were found, except for differences in surgery duration (Table 2).

Conclusion:

Fetal head station per se is not associated with adverse maternal and neonatal outcomes in second-stage cesarean delivery.