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Duration of labor and the risk of severe postpartum hemorrhage: A case-control study

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ABSTRACT

Objective: Our main objective was to investigate the association between duration of active labor and severe postpartum hemorrhage. We examined the effect of the total duration of active labor, the effect of each stage of active labor, and the gradient effect of duration of labor on severe postpartum hemorrhage.

Methods: A case-control study was generated from a source population of all women admitted for delivery at Oslo University Hospital and Drammen Hospital in Buskerud municipality during the time period January 1, 2008 to December 31, 2011. The study population included all cases of severe postpartum hemorrhage (n = 859) and a random sample of controls (n = 1755). Severe postpartum hemorrhage was defined as postpartum blood loss ≥1500 mL or need for blood transfusion. Prolonged labor was defined as duration of active labor >12 hours according to the definition of the World Health Organization. We used logistic multivariable regression in the analysis.

Results: We observed a significantly longer mean duration of labor in women who experienced severe postpartum hemorrhage compared to controls (5.4 versus 3.8 hours, p<0.001). Women with severe postpartum hemorrhage also had a longer duration of all stages of active labor compared to controls. The association between the duration of active labor and severe postpartum changed from a linear dose-response association to a threshold association after adjusting for augmentation with oxytocin, induction of labor, primiparity, and fever during labor. Compared to controls, women with severe postpartum hemorrhage were more likely to have a prolonged labor >12 hours (adjusted odds ratio = 2.44, 95% confidence interval: 1.69–3.53, p< 0.001).

Conclusion: Prolonged active labor (duration >12 hours) was associated with severe postpartum hemorrhage. Increased vigilance seems required when the labor is prolonged to reduce the risk of severe postpartum hemorrhage.

No MeSH data available.


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Selection of study subjects.PPH = postpartum hemorrhage.
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pone.0175306.g001: Selection of study subjects.PPH = postpartum hemorrhage.

Mentions: The source population was all women admitted for labor at gestational week ≥23 at two University Hospitals in Oslo (Ullevaal and Rikshospitalet) and Drammen Hospital in Buskerud municipality during the period January 1, 2008 to December 31, 2011. After exclusion of women with planned caesarean deliveries, we extracted the study population, which included all cases of severe PPH (n = 859) and a random sample of controls without severe PPH (n = 1755) (Fig 1).


Duration of labor and the risk of severe postpartum hemorrhage: A case-control study
Selection of study subjects.PPH = postpartum hemorrhage.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383278&req=5

pone.0175306.g001: Selection of study subjects.PPH = postpartum hemorrhage.
Mentions: The source population was all women admitted for labor at gestational week ≥23 at two University Hospitals in Oslo (Ullevaal and Rikshospitalet) and Drammen Hospital in Buskerud municipality during the period January 1, 2008 to December 31, 2011. After exclusion of women with planned caesarean deliveries, we extracted the study population, which included all cases of severe PPH (n = 859) and a random sample of controls without severe PPH (n = 1755) (Fig 1).

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Our main objective was to investigate the association between duration of active labor and severe postpartum hemorrhage. We examined the effect of the total duration of active labor, the effect of each stage of active labor, and the gradient effect of duration of labor on severe postpartum hemorrhage.

Methods: A case-control study was generated from a source population of all women admitted for delivery at Oslo University Hospital and Drammen Hospital in Buskerud municipality during the time period January 1, 2008 to December 31, 2011. The study population included all cases of severe postpartum hemorrhage (n = 859) and a random sample of controls (n = 1755). Severe postpartum hemorrhage was defined as postpartum blood loss ≥1500 mL or need for blood transfusion. Prolonged labor was defined as duration of active labor >12 hours according to the definition of the World Health Organization. We used logistic multivariable regression in the analysis.

Results: We observed a significantly longer mean duration of labor in women who experienced severe postpartum hemorrhage compared to controls (5.4 versus 3.8 hours, p<0.001). Women with severe postpartum hemorrhage also had a longer duration of all stages of active labor compared to controls. The association between the duration of active labor and severe postpartum changed from a linear dose-response association to a threshold association after adjusting for augmentation with oxytocin, induction of labor, primiparity, and fever during labor. Compared to controls, women with severe postpartum hemorrhage were more likely to have a prolonged labor >12 hours (adjusted odds ratio = 2.44, 95% confidence interval: 1.69–3.53, p< 0.001).

Conclusion: Prolonged active labor (duration >12 hours) was associated with severe postpartum hemorrhage. Increased vigilance seems required when the labor is prolonged to reduce the risk of severe postpartum hemorrhage.

No MeSH data available.


Related in: MedlinePlus