Prolonged second stage of labor and postpartum hemorrhage.

OBJECTIVE To examine the relationship between prolonged second stage and postpartum hemorrhage (PPH). METHODS We conducted a retrospective case-control study of all cases of PPH which occurred at four Southern California hospitals in 2003. Cases were identified by ICD-9 codes and confirmed by chart reviews, and non-cases were randomly selected as controls. The relationship between PPH and prolonged second-stage was examined using bivariate and multivariate analyses. RESULTS The sample consisted of 91 cases and 323 controls. Cases were significantly more likely than controls to have had a prolonged second stage of labor, over a range of definitions for PPH and prolonged second stage. In multivariable analyses, prolonged second stage was associated with greater than three-fold (OR = 3.35; 95% CI 1.22-9.19) increased risk for PPH. CONCLUSION Prolonged second stage is an important risk factor for PPH. Close supervision is warranted for women with a prolonged second stage.