Obstetric characteristics for a prolonged third stage of labor and risk for postpartum hemorrhage

Abstract

Aim: To determine the obstetric characteristics associated with a prolonged third stage of labor and risk factors for a postpartum hemorrhage (PPH) in women undergoing vaginal delivery.

Method: Secondary analysis of a prospective randomized investigation comparing placental removal at 20 versus 30 min to prevent PPH.

Results: Between 1 March 2004 and 1 March 2005, 1,607 women were recruited. Eighty-nine percent of the placentas had delivered by 10 min (n = 1,430) and 10.5% (n = 168) had delivered between 10 and 20 min, leaving 8 retained placentas (0.5%) >20 min. Simultaneous factors predictive of longer duration of third stage of labor included maternal age > or =35 years (hazard ratio HR = 0.990, 95% CI 0.981-0.999, p = 0.030) and duration of second stage of labor >2 h (HR = 0.745, 95% CI 0.628-0.883, p = 0.001) relative to second stage of labor <1 h. Significant risk factors for PPH included chorioamnionitis (odds ratio OR = 6.45, 95% CI 2.37-17.64, p < 0.001), nulliparity (OR = 2.38, 95% CI 1.19-4.77, p = 0.014), overdistended uterus (OR = 2.81, 95% CI 1.02-7.76, p = 0.047) and third stage of labor >10 min (OR = 6.45 95%, CI 2.73-22.84, p < 0.001 compared with third stage < or =5 min).

Conclusions: Prolonged third stage of labor is correlated with an older maternal age and a prolonged second stage of labor. Significant risk factors for PPH include chorioamnionitis, an overdistended uterus and a third stage of labor >10 min.