EP19.19: Angle of progression for predicting second‐stage Caesarean delivery complications

Caesarean delivery (CD) at full cervical dilation is technically challenging and predisposes the mother to surgical complications. The study aims to investigate the correlation between the angle of progression (AOP) and maternal surgical complications following a second-stage CD. We retrospectively evaluated all women with singleton pregnancy at term who underwent CD for arrest of descent at the second stage of labour between 2022 and 2023. Only cases with recorded AOP were included. The fetal head position was confirmed by transabdominal ultrasound. The composite adverse maternal outcome included challenging fetal extraction, uterine extension, requirement for blood transfusions, postpartum fever, ileus, and re-hospitalisation. Twenty-five cases met the inclusion criteria, of whom 17 (68%) were in occupier-posterior fetal position. Logistic regression analysis showed a significant correlation between measured AOP and composite maternal outcome (P = .028, see figure 1). The predicted probability for composite adverse maternal outcome by receiver-operating characteristics curve yielded an area under the curve of 0.79 (CI 0.60-0.98) for AOP, compared to 0.53 (CI 0.30-0.75) for the traditionally measured fetal head station. Our study has demonstrated a correlation between AOP and maternal complications following second-stage CD. Assessing AOP before surgery may be of value for the obstetrical team to better identify susceptible cases and allow for appropriate preparation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.