Maternal outcomes according to fetal head station at diagnosis of the second stage of labor.

Authors

Itamar Gilboa, Daniel Gabbai, Anat Lavie, Or Rosentveig, Yoav Baruch, Yariv Yogev, Emmanuel Attali

Published in

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. Jul 21, 2026. Epub Jul 21, 2026.

Abstract

This study determines the association between fetal head station (FHS) at the diagnosis of the second stage of labor and adverse maternal outcomes.
This retrospective cohort study was conducted at a single university-affiliated tertiary medical center from 2011 to 2023, including singleton vertex deliveries at ≥ 37 weeks of gestation. Participants were stratified by parity FHS at the diagnosis of the second stage: nulliparous (Group A: above the ischial spines, Group B: at the ischial spines, Group C: below the ischial spines) and multiparous (Group α: above the ischial spines, Group β: at the ischial spines, Group γ: below the ischial spines). The composite maternal outcome included red blood cell transfusion, third- or fourth-degree perineal tears, postpartum fever ≥38°C, intensive care unit admission, rehospitalization, or surgery within 6 weeks postpartum.
Of 146 194 deliveries, 64 349 were eligible (42 987 nulliparous; 21 362 multiparous). Among nulliparas, 8.0%, 34.9%, and 57.2% began the second stage above, at, and below the spines, respectively; corresponding multiparous rates were 14.7%, 27.8%, and 57.5%. Nulliparas in Group A had higher transfusion rates (2.7% vs. 1.9% and 1.4%; P < 0.001) and higher composite morbidity (5.6% vs. 4.6% and 4.1%; P < 0.001). In multivariable regression, FHS above the ischial spines remained independently associated with increased risk for red blood cell transfusion (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-1.9) and composite morbidity (OR 1.3, 95% CI 1.1-1.5). No association was observed among multiparous women.
In nulliparous women, a higher FHS at the onset of the second stage of labor is independently associated with an increased risk of postpartum complications, irrespective of second stage duration.

PMID:
42479934
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

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