Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Feb 11;25(1):143.
doi: 10.1186/s12884-025-07229-4.

Duration of the second and third stages of labor and risk of postpartum hemorrhage: a cohort study stratified by parity

Sandrine Voillequin  1   2 , T Quibel  3   4 , P Rozenberg  3   5 , A Rousseau  3   4
Affiliations
Randomized Controlled Trial

Duration of the second and third stages of labor and risk of postpartum hemorrhage: a cohort study stratified by parity

Sandrine Voillequin et al. BMC Pregnancy Childbirth. .

Abstract

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. It is therefore important to improve our understanding of the risk factors for PPH according to parity, in particular, those linked to modifiable obstetric practices. The aim of this study was to assess the risk of PPH by the duration of the second and third stages of labor, stratified by parity.

Methods: This study was based on secondary analysis of data from participants in a randomized controlled trial. A sample of women from three university hospitals in France aged at least 18 years, with a singleton pregnancy, in the first stage of labor, at 36-42 weeks of gestation, with epidural anesthesia and a vaginal delivery were included. The main outcome was PPH rates, defined by blood loss > 500 mL within 2 h after delivery. Characteristics of mothers, newborns, labor, and delivery, and their relation to PPH were explored with multivariable regression models.

Results: Of 1598 women included, 864 were nulliparous and 680 parous; their respective PPH rates were 9.1% (79/864) and 7.4% (54/680) (P = 0.2), and the overall rate 8.3% (133/1598). The multivariable analysis found that PPH was associated with the durations of both oxytocin exposure (aOR 1.10, 95%CI 1.01-1.20) and the third stage of labour (aOR 1.80, 95%CI 1.37-2.38) among nulliparous women, and the PPH risk increased with both duration of the third stage (aOR 2.10, 95%CI 1.56-2.83) and history of PPH (aOR 3.02, 95%CI 1.38-6.59) among parous women.

Conclusions: The duration of oxytocin exposure was found to be a risk factor for PPH among nulliparous women as was a history of PPH among parous women. Future studies should focus on duration of third stage of labor, especially when active management of the third stage of labor (AMTSL) is routinely used.

Trial registration: The trial was registered at ClinicalTrials.gov NCT01113229.

Keywords: Parity; Postpartum hemorrhage; Risk factors; Stage of labor.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: ClinicalTrials.gov, https://clinicaltrials.gov , NCT01113229. We confirm that all methods were performed in accordance with the relevant guidelines and regulations. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Global Health. 2014;2:e323–33. - PubMed
    1. Bateman BT, Berman MF, Riley LE, Leffert LR. The Epidemiology of Postpartum Hemorrhage in a large. Nationwide Sample Deliveries: Anesth Analgesia. 2010;110:1368–73. - PubMed
    1. Combs CA, Murphy EL, Laros RK. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77:69–76. - PubMed
    1. Ende HB, Lozada MJ, Chestnut DH, Osmundson SS, Walden RL, Shotwell MS, et al. Risk factors for Atonic Postpartum Hemorrhage. Obstet Gynecol. 2021;137:305–23. - PMC - PubMed
    1. Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita ATN. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. Am J Obstet Gynecol. 2013;209:e511–6. - PMC - PubMed

Publication types

Associated data

LinkOut - more resources