TY - JOUR
T1 - Duration of Second Stage of Labour at Term and Pushing Time
T2 - Risk Factors for Postpartum Haemorrhage
AU - Looft, Emelie
AU - Simic, Marija
AU - Ahlberg, Mia
AU - Snowden, Jonathan M.
AU - Cheng, Yvonne W.
AU - Stephansson, Olof
N1 - Funding Information:
This study was supported by grants from the Swedish Research Council (2013-2429, OS) and by grants provided by the Stockholm County Council (ALF project 20130156, OS). The funding sources had no involvement in conduct of the research or preparation of the article.
Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background: Prolonged labour is associated with increased risk of postpartum haemorrhage (PPH), but the role of active pushing time and the relation with management during labour remains poorly understood. Methods: A population-based cohort study from electronic medical record data in the Stockholm-Gotland Region, Sweden. We included 57 267 primiparous women with singleton, term gestation, livebirths delivered vaginally in cephalic presentation in 2008–14. We performed multivariable Poisson regression to estimate the association between length of second stage, pushing time, and PPH (estimated blood loss >500 mL during delivery), adjusting for maternal, delivery, and fetal characteristics as potential confounders. Results: The incidence of PPH was 28.9%. The risk of PPH increased with each passing hour of second stage: compared with a second stage <1 h, the adjusted relative risk (RR) for PPH were for 1 to <2 h 1.10 (95% confidence interval (CI) 1.07, 1.14); for 2 to <3 h 1.15 (95% CI 1.10, 1.20); for 3 to <4 h 1.28 (95% CI 1.22, 1.33); and for ≥4 h 1.40 (95% CI 1.33, 1.46). PPH also increased with pushing time exceeding 30 min. Compared to pushing time between 15 and 29 min, the RR for PPH were for <15 min 0.98 (95% CI 0.94, 1.03); for 30–44 min 1.08 (95% CI 1.04, 1.12); for 45–59 min 1.11 (95% CI 1.06, 1.16); and for ≥60 min 1.20 (95% CI 1.15, 1.25). Conclusions: Increased length of second stage and pushing time during labour are both associated with increased risk of PPH.
AB - Background: Prolonged labour is associated with increased risk of postpartum haemorrhage (PPH), but the role of active pushing time and the relation with management during labour remains poorly understood. Methods: A population-based cohort study from electronic medical record data in the Stockholm-Gotland Region, Sweden. We included 57 267 primiparous women with singleton, term gestation, livebirths delivered vaginally in cephalic presentation in 2008–14. We performed multivariable Poisson regression to estimate the association between length of second stage, pushing time, and PPH (estimated blood loss >500 mL during delivery), adjusting for maternal, delivery, and fetal characteristics as potential confounders. Results: The incidence of PPH was 28.9%. The risk of PPH increased with each passing hour of second stage: compared with a second stage <1 h, the adjusted relative risk (RR) for PPH were for 1 to <2 h 1.10 (95% confidence interval (CI) 1.07, 1.14); for 2 to <3 h 1.15 (95% CI 1.10, 1.20); for 3 to <4 h 1.28 (95% CI 1.22, 1.33); and for ≥4 h 1.40 (95% CI 1.33, 1.46). PPH also increased with pushing time exceeding 30 min. Compared to pushing time between 15 and 29 min, the RR for PPH were for <15 min 0.98 (95% CI 0.94, 1.03); for 30–44 min 1.08 (95% CI 1.04, 1.12); for 45–59 min 1.11 (95% CI 1.06, 1.16); and for ≥60 min 1.20 (95% CI 1.15, 1.25). Conclusions: Increased length of second stage and pushing time during labour are both associated with increased risk of PPH.
KW - labour
KW - postpartum haemorrhage
KW - prospective cohort study
KW - pushing
KW - second stage
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U2 - 10.1111/ppe.12344
DO - 10.1111/ppe.12344
M3 - Article
C2 - 28195653
AN - SCOPUS:85013195141
SN - 0269-5022
VL - 31
SP - 126
EP - 133
JO - Paediatric and Perinatal Epidemiology
JF - Paediatric and Perinatal Epidemiology
IS - 2
ER -