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The Journal of Maternal-Fetal & Neonatal Medicine Volume 22, 2009 - Issue 3
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Original Article

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
Pages 227-232 | Received 30 Jun 2008, Accepted 03 Dec 2008, Published online: 07 Jul 2009
 
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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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