title: Second stage of labor and intraventricular hemorrhage in early preterm infants in the vertex presentation.
abstract: OBJECTIVE
  To investigate the association between exposure to second stage of labor and duration of second stage, and risk of intraventricular hemorrhage (IVH) among infants delivered <30 weeks of gestation.
  
  
  METHODS
  We conducted a retrospective cohort study among 158 singleton vertex deliveries (97 vaginal and 61 cesarean). Multivariable logistic regression was used to evaluate the risk of IVH related to second stage.
  
  
  RESULTS
  Infants exposed to second stage as compared to those not exposed to second stage irrespective of their mode of delivery had increased risk of mild IVH (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.15, 6.29) but not of severe IVH (OR 1.14; 95% CI 0.33, 3.84). No relation with risk of mild (OR 0.98; 95% CI 0.95, 1.01) and severe (OR 1.00; 95% CI 0.95, 1.05) IVH was observed for each 1 min increase in duration of second stage. We also observed no significant association between quartiles of duration of second stage and risk of mild (p = 0.20) and severe (p = 0.29) IVH. We did not observe any significant interaction by gestational age, chorioamnionitis, birth weight or presenting complaint on admission.
  
  
  CONCLUSIONS
  The risk of mild IVH was increased in those exposed to a second stage of labor. However, no clear association was observed between duration of second stage and mild or severe IVH.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital , Memphis, TN 38105-2794, USA. prasad.gawade@stjude.org
authors.forename: Prasad L
authors.initials: PL
authors.lastname: Gawade
authors.forename: Brian W
authors.initials: BW
authors.lastname: Whitcomb
authors.forename: Lisa
authors.initials: L
authors.lastname: Chasan-Taber
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.forename: Alayne G
authors.initials: AG
authors.lastname: Ronnenberg
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Shah
authors.forename: Michael P
authors.initials: MP
authors.lastname: Plevyak
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Markenson
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000151:congenital* / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000209:etiology*; D007746:Labor Presentation; D007748:Labor Stage, Second / Q000502:physiology*; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult