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