The duration of the third stage in relation to postpartum hemorrhage

Abstract

Introduction In this study, we describe the distribution of placenta delivery and the incidence of postpartum hemorrhage in both spontaneous placental delivery and manual removal of the placenta. Methods A retrospective study was performed of 7603 singleton vaginal deliveries of a gestational age over 32 weeks, registered between September 2011 and 2016. We calculated the incidence of postpartum hemorrhage (≥1000 mL blood loss) per 10‐minute duration of the third stage. The odds ratio for developing postpartum hemorrhage was assessed, adjusted for risk factors. The incidence of postpartum hemorrhage was compared between women that did and did not receive manual removal of placenta. Results The median duration of the third stage was 10 minutes (interquartile range 7‐16 minutes). The median amount of blood loss was 300 mL (200‐400 mL). The overall incidence of postpartum hemorrhage was 8.5%. With every additional 10 minutes of third‐stage duration, the risk of developing postpartum hemorrhage significantly increased. In a third stage longer than 60 minutes, the incidence of postpartum hemorrhage was 21.2% without manual removal of the placenta and 70.3% with manual removal. Conclusions The incidence of postpartum hemorrhage increases significantly from 10 to 19 minutes into the third stage. Women with the removal of the placenta had a significantly higher percentage of postpartum hemorrhage. The optimal timing for manual removal of the placenta should be investigated in a carefully designed randomized controlled trial to examine whether earlier manual removal of placenta lowers the incidence and limits the severity of postpartum hemorrhage.

Evaluation of the effect of dinoprostone vaginal ovule for cervical maturation and labor induction in term pregnancies on the duration of the third stage of labor and amount of postpartum bleeding

“…Our study found that a prolonged 3rd stage of labor was associated with an increased risk of severe postpartum hemorrhage. This finding is consistent with previous studies that have reported an increased risk of postpartum hemorrhage with a longer 3rd stage duration of labor [10,17]. Additionally, our study found that an increase in BMI was associated with an increased risk of severe postpartum hemorrhage, which aligns with previous studies reporting obesity as a risk factor for postpartum hemorrhage [19].…”

“…In the literature, studies have shown that as the duration of the 3rd stage of labor increases, the amount and risk of postpartum hemorrhage also increase. In a study by Manon Van Ast et al [10] that examined 7,203 single vaginal deliveries, the group with postpartum hemorrhage had a median duration of the 3rd stage of labor of 26 min, while the group without postpartum hemorrhage had a median duration of 10 min. There was a statistically significant difference between these values.…”

“…The 3rd stage duration of labor varies between 6 and 30 min, with an average blood loss of approximately 150-250 ml [9]. Patients whose placenta separates within the first 10 min tend to experience the least bleeding [10].…”