Prolonged second stage of labor and postpartum hemorrhage

Michael C. Lu Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Community Health Sciences; Center for Healthier Children, Families and Communities, UCLA School of Public Health, Los Angeles, California, USACorrespondence[email protected]

Eunice Muthengi Department of Community Health Sciences

Fathima Wakeel Department of Community Health Sciences

Moshe Fridman AMF Consulting, Inc, Los Angeles, California, USA

Lisa M. Korst Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

Kimberly D. Gregory Center for Healthier Children, Families and Communities, UCLA School of Public Health, Los Angeles, California, USA; Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Cedars-Sinai Medical Center and Burns Allen Research Institute, Los Angeles, California, USA

Abstract

Objective. To examine the relationship between prolonged second stage and postpartum hemorrhage (PPH).

Methods. We conducted a retrospective case–control study of all cases of PPH which occurred at four Southern California hospitals in 2003. Cases were identified by ICD-9 codes and confirmed by chart reviews, and non-cases were randomly selected as controls. The relationship between PPH and prolonged second-stage was examined using bivariate and multivariate analyses.

Results. The sample consisted of 91 cases and 323 controls. Cases were significantly more likely than controls to have had a prolonged second stage of labor, over a range of definitions for PPH and prolonged second stage. In multivariable analyses, prolonged second stage was associated with greater than three-fold (OR = 3.35; 95% CI 1.22–9.19) increased risk for PPH.

Conclusion. Prolonged second stage is an important risk factor for PPH. Close supervision is warranted for women with a prolonged second stage.

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Prolonged second stage of labor and postpartum hemorrhage

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Prolonged second stage of labor and postpartum hemorrhage

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