Cesarean Delivery Among Nulliparous Term Pregnancies with Hypertensive Disorders - 09/09/26

Doi : 10.1016/j.jogoh.2026.103277

Rachel L Solmonovich ^1,^⁎ , Insaf Kouba ², Alejandro Alvarez ³, Frank Jackson ^4,^5,⁶, Jamie Green ^4,^5,⁶, Dominique Ketsoglou ^4,^5,⁶, Kristen Demertzis ^4,^5,⁶, Matthew J Blitz ^4,^5,^6,⁷

¹ Department of Reproductive Endocrinology and Infertility, Montefiore Einstein, Bronx, NY

² Department of Maternal Fetal Medicine, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL

³ Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, NY 11042, USA

⁴ Northwell, New Hyde Park, NY

⁵ Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY 11706, USA

⁶ Zucker School of Medicine, Hempstead, NY

⁷ Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY

^⁎ Corresponding author.

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Wednesday 09 September 2026

ABSTRACT

OBJECTIVES

To identify clinical and sociodemographic factors associated with cesarean delivery (CD) among nulliparous, term, singleton, vertex (NTSV) mothers with hypertensive disorders of pregnancy (HDP), and to determine if severity of HDP illness is associated with CD, as denoted by presence or absence of preeclampsia with severe features (sPEC).

METHODS

Retrospective cohort of NTSV-HDP pregnancies delivered within a large academic health system in New York from 2019-2022. The primary exposure of interest was sPEC. The primary outcome was CD. A subanalysis was performed among pregnancies with sPEC to evaluate whether abnormal laboratory values or acute hypertension treatment are associated with CD. Mixed models logistic regression was performed to adjust for covariate factors.

RESULTS

A total of 5,202 NTSV-HDP pregnancies were included for analysis: 27.8% had sPEC. The overall CD rate was 37.5%. On logistic regression, sPEC was associated with 1.41 higher odds of CD compared to pregnancies without sPEC (95% CI 1.23-1.61). In the sPEC cohort, no association was seen between having abnormal laboratory testing and/or acute hypertension treatment and CD.