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Original Article

Risk Factors for a Prolonged Third Stage of Labor and Postpartum Hemorrhage

Everett F. Magann, MD, Monica A. Lutgendorf, MD, Sharon D. Keiser, MD, Stephanie Porter, MSN, WHNP-BC, Eric R. Siegel, MS,Samantha A. McKelvey, MD, John C. Morrison, MD
Volume: 106 Issue: 2 February, 2013

Abstract:

Objectives: To determine the effect of a third stage of labor ≥15 minutes on bleeding after delivery and other risk factors for a postpartum hemorrhage (PPH).


Methods: This was a case-control study of women undergoing vaginal delivery with placental delivery ≥15 minutes matched by gestational age to the next delivery with placental delivery <15 minutes. Multiple risk factors were evaluated for association with delayed placenta and with PPH.


Results: There were 226 pregnancies ≥15 minutes (cases) versus 226 whose placental time was <15 minutes (controls). The best-fit model identified placental delivery ≥15 minutes, history of retained placenta, nulliparity, and increased length of first stage of labor as significant factors for PPH.


Conclusions: The best risk model for PPH includes placental delivery ≥15 minutes, history of retained placenta, nulliparity, and longer first stage of labor.

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