Liang Shuang, Zheng Wenguang, Zhao Ying, Su Baotong, Cui Hongyan, Lv Yan, Jia Yanjiu, Chen Xu
Tianjin Central Hospital of Gynecology Obstetrics/Nankai University Affiliated Maternity Hospital, Tianjin, China.
Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China.
Int J Gynaecol Obstet. 2025 Jan;168(1):141-148. doi: 10.1002/ijgo.15816. Epub 2024 Aug 2.
To conduct an analysis using propensity score methods, exploring the association between a prolonged second stage (>3 h) and the risk of postpartum hemorrhage (PPH) in a diverse population.
We conducted a prospective cohort study involving nullipara with epidural anesthesia and vaginal delivery, aged ≥18 years, presenting cephalically, and with a gestational age (GA) of ≥24 weeks at a tertiary maternity hospital in China (chictr.org.cn identifier: ChiCTR2200063094). Women undergoing emergency cesarean section in labor were excluded. The primary outcome was PPH, with secondary outcomes including severe postpartum hemorrhage and blood transfusion. We employed propensity score overlap weighting to analyze the association between prolonged second stage labor and PPH.
The study included 3643 nullipara with epidural anesthesia, comprising 77 with a second stage of labor >3 h and 3566 with a second stage ≤3 h. Utilizing propensity score overlap weighting, there were no significant differences observed between the two groups regarding the risk of PPH (29.87% in >3 h group vs 17.64% in ≤3 h group; weighted odds ratio 1.01; 95% CI: 0.51-2.02). Subgroup interaction tests for PPH were not significant for assisted vaginal delivery, induction of labor, macrosomia, third-/fourth-degree perineal laceration, GA >41 weeks, twin pregnancies, episiotomy and GA >37 weeks. Sensitivity analysis did not reveal significant differences.
This study did not find evidence supporting an increased risk of PPH associated with a second stage of labor lasting >3 h in our population, providing additional evidence for clinical practice.
采用倾向评分法进行分析，探讨不同人群中第二产程延长（>3小时）与产后出血（PPH）风险之间的关联。
我们在中国一家三级妇产医院进行了一项前瞻性队列研究，纳入年龄≥18岁、头先露、孕周（GA）≥24周且接受硬膜外麻醉并经阴道分娩的初产妇（中国临床试验注册中心标识符：ChiCTR2200063094）。排除分娩时接受急诊剖宫产的妇女。主要结局为PPH，次要结局包括严重产后出血和输血。我们采用倾向评分重叠加权法分析第二产程延长与PPH之间的关联。
该研究纳入了3643例接受硬膜外麻醉的初产妇，其中77例第二产程>3小时，3566例第二产程≤3小时。利用倾向评分重叠加权法，两组在PPH风险方面未观察到显著差异（>3小时组为29.87%，≤3小时组为17.64%；加权比值比为1.01；95%置信区间：0.51 - 2.02）。PPH的亚组交互检验在助产阴道分娩、引产、巨大儿、会阴三度/四度裂伤、GA>41周、双胎妊娠、会阴切开术和GA>37周方面无显著差异。敏感性分析未发现显著差异。
本研究未发现证据支持在我们的人群中第二产程持续>3小时会增加PPH风险，为临床实践提供了额外证据。
