Prolonged second stage of labor and postpartum hemorrhage.
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.


CONCLUSIONS
Prolonged second stage is an important risk factor for PPH. Close supervision is warranted for women with a prolonged second stage.
Lu
Michael C
MC
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1772, USA. mclu@ucla.edu
Muthengi
Eunice
E
Wakeel
Fathima
F
Fridman
Moshe
M
Korst
Lisa M
LM
Gregory
Kimberly D
KD