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Risk of postpartum hemorrhage with increasing first stage labor duration.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Reproductive Health

Background:

  • Postpartum hemorrhage (PPH) rates are rising in high-income nations.
  • The impact of labor duration on PPH risk requires further investigation.

Purpose of the Study:

  • To examine the association between active first stage labor duration and PPH risk.
  • To explore the mediating roles of second stage labor duration and cesarean delivery (CD) in this relationship.

Main Methods:

  • Study included 77,690 nulliparous women with spontaneous labor onset.
  • Labor stages defined by cervical dilation and time to birth.
  • Modified Poisson regression and mediation analysis used to assess risk and associations.

Main Results:

  • A first stage of labor exceeding 12.1 hours was associated with a 1.5-fold increased PPH risk compared to labor under 7.7 hours.
  • Prolonged first stage labor accounted for 18.5% of increased PPH risk, mediated by prolonged second stage labor or CD.
  • Cesarean delivery and prolonged second stage labor were identified as significant mediators.

Conclusions:

  • Active first stage labor duration is a critical factor in identifying PPH risk for nulliparous women.
  • Incorporating first stage labor duration into intrapartum assessments can enhance PPH risk prediction.
  • This finding is particularly relevant for first-time mothers with spontaneous onset of labor for a term, singleton, vertex presentation fetus.