title: Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period.
abstract: OBJECTIVE
  To study the association between duration of second stage of labour and risks of maternal complications (infection, urinary retention, haematoma or ruptured sutures) in the early postpartum period.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  We included 72 593 mothers with singleton vaginal deliveries at ≥37 weeks of gestation in cephalic presentation, using the obstetric database from the Stockholm-Gotland region in Sweden, 2008-12.
  
  
  METHODS
  Logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated and adjustments were made for maternal age, body mass index, height, smoking, cohabitation, gestational age, labour induction, epidural analgesia and oxytocin augmentation.
  
  
  RESULTS
  Rates of any complication varied by parity from 7.3% in parous women with previous caesarean section, 4.8% in primiparas and 1.7% in parous women with no previous caesarean section. Compared with a second stage <1 hour, the adjusted ORs for any complication (95% CI) in primiparas were for 1 to <2 hours 1.28 (1.11-1.47); 2 to <3 hours 1.54 (1.32-1.79), 3 to <4 hours 1.63 (1.38-1.93) and ≥4 hours 2.08 (1.74-2.49). The corresponding adjusted ORs for parous women without previous caesarean were 2.27 (1.78-2.90), 2.97 (2.09-4.22), 3.65 (2.25-5.94) and 3.16 (1.44-6.94), respectively. The adjusted ORs for women with previous caesarean were for 1 to <2 hours 1.62 (1.13-2.32); 2 to <3 hours 1.56 (1.00-2.43), 3 to <4 hours 2.42 (1.52-3.87), and ≥4 hours 2.31 (1.25-4.24).
  
  
  CONCLUSIONS
  Risks of maternal complications in the postpartum period increase with duration of second stage of labour also after accounting for maternal, pregnancy and delivery characteristics. Special attention has to be given to parous women with previous caesarean deliveries.
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.|Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital and Institutet, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Stephansson
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.|Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital and Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Sandström
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Petersson
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.|Department of Women's and Children's Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
authors.forename: A-K
authors.initials: AK
authors.lastname: Wikström
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Cnattingius
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D007751:Labor, Induced; D016017:Odds Ratio; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D011645:Puerperal Infection / Q000453:epidemiology*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016055:Urinary Retention / Q000453:epidemiology*
keywords: Infectious disease; labour; postpartum; second stage; urinary retention