title: Tranfusion risk: is "two-step" vaginal delivery a risk for postpartum hemorrhage?
abstract: OBJECTIVE
  In the active management strategy of third stage of labor, the optimal timing for clamping the umbilical cord after birth has been a subject of controversy. We want to evaluate if "two-step" delivery is a risk factor for postpartum hemorrhage (PPH), defined as need of transfusion, comparing to operative delivery, elective caesarean delivery and emergency caesarean delivery.
  
  
  METHODS
  This is a retrospective cohort study conducted in division of Perinatal Medicine, Policlinico Abano Terme. We evaluated the need of transfusion in all cases of PPH verified in all single deliveries between January 2011 and December 2012. The main outcome measure was blood loss and red blood cell transfusion.
  
  
  RESULTS
  We found 17 cases of PPH (0.88%). The distribution of PPH in relation to mode of delivery was 0.71%, 2.46% and 1.98% respectively for two-step vaginal delivery (RR = 0.81 (0.56-1.22)), emergency cesarean section (RR = 2.88 (1.27-7.77)) and operative vaginal delivery (RR = 2.88 (0.59-5.66)). In labor induction there is a stronger relative risk association between PPH and as emergency cesarean delivery (p < 0.05) as operative vaginal delivery (p < 0.05).
  
  
  CONCLUSIONS
  "Two-step" delivery approach did not increase the risk of PPH with respect to operative delivery, elective caesarean section and emergency caesarean section.
authors.affiliation: a Division of Perinatal Medicine , Policlinico Abano Terme , Abano Terme , Italy and.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Straface
authors.affiliation: a Division of Perinatal Medicine , Policlinico Abano Terme , Abano Terme , Italy and.
authors.forename: Emma
authors.initials: E
authors.lastname: Bassi
authors.affiliation: b Department of Obstetrics and Gynaecology , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: De Santis
authors.affiliation: b Department of Obstetrics and Gynaecology , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: a Division of Perinatal Medicine , Policlinico Abano Terme , Abano Terme , Italy and.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Zanardo
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D010043:Outcome and Process Assessment, Health Care; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014470:Umbilical Cord
keywords: Blood cell transfusion; cord-clamping time; third stage labor