Risk Factors for a Prolonged Third Stage of Labor and Postpartum Hemorrhage

Objectives: To determine the effect of a third stage of labor >= 15 minutes on bleeding after delivery and other risk factors for a postpartum hemorrhage (PPH). Methods: This was a case-control study of women undergoing vaginal delivery with placental delivery >= 15 minutes matched by gestational age to the next delivery with placental delivery <15 minutes. Multiple risk factors were evaluated for association with delayed placenta and with PPH. Results: There were 226 pregnancies >= 15 minutes (cases) versus 226 whose placental time was <15 minutes (controls). The best-fit model identified placental delivery >= 15 minutes, history of retained placenta, nulliparity, and increased length of first stage of labor as significant factors for PPH. Conclusions: The best risk model for PPH includes placental delivery >= 15 minutes, history of retained placenta, nulliparity, and longer first stage of labor.