{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T23:13:52Z","timestamp":1777158832744,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T00:00:00Z","timestamp":1722556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2021YFC2701500"],"award-info":[{"award-number":["2021YFC2701500"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019065","name":"Tianjin Municipal Science and Technology Program","doi-asserted-by":"publisher","award":["21JCZDJC00080"],"award-info":[{"award-number":["21JCZDJC00080"]}],"id":[{"id":"10.13039\/501100019065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To conduct an analysis using propensity score methods, exploring the association between a prolonged second stage (&gt;3\u2009h) and the risk of postpartum hemorrhage (PPH) in a diverse population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective cohort study involving nullipara with epidural anesthesia and vaginal delivery, aged \u226518\u2009years, presenting cephalically, and with a gestational age (GA) of \u226524\u2009weeks at a tertiary maternity hospital in China (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/chictr.org.cn\">chictr.org.cn<\/jats:ext-link> 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 3643 nullipara with epidural anesthesia, comprising 77 with a second stage of labor &gt;3\u2009h and 3566 with a second stage \u22643\u2009h. Utilizing propensity score overlap weighting, there were no significant differences observed between the two groups regarding the risk of PPH (29.87% in &gt;3\u2009h group vs 17.64% in \u22643\u2009h group; weighted odds ratio 1.01; 95% CI: 0.51\u20132.02). Subgroup interaction tests for PPH were not significant for assisted vaginal delivery, induction of labor, macrosomia, third\u2010\/fourth\u2010degree perineal laceration, GA &gt;41\u2009weeks, twin pregnancies, episiotomy and GA &gt;37\u2009weeks. Sensitivity analysis did not reveal significant differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study did not find evidence supporting an increased risk of PPH associated with a second stage of labor lasting &gt;3\u2009h in our population, providing additional evidence for clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.15816","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T09:50:37Z","timestamp":1722592237000},"page":"141-148","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prolonged second stage of labor and risk of postpartum hemorrhage in nullipara with epidural anesthesia and vaginal delivery: A cohort study with propensity score analysis"],"prefix":"10.1002","volume":"168","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9059-9130","authenticated-orcid":false,"given":"Shuang","family":"Liang","sequence":"first","affiliation":[{"name":"Tianjin Central Hospital of Gynecology Obstetrics\/Nankai University Affiliated Maternity Hospital  Tianjin China"},{"name":"Tianjin Key Laboratory of Human Development and Reproductive Regulation  Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenguang","family":"Zheng","sequence":"additional","affiliation":[{"name":"School of Computer Science and Engineering Tianjin University of Technology  Tianjin China"},{"name":"Tianjin Key Laboratory of Intelligence Computing and Novel Software Technology Tianjin University of Technology  Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Medicine Nankai University  Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baotong","family":"Su","sequence":"additional","affiliation":[{"name":"School of Computer Science and Engineering Tianjin University of Technology  Tianjin China"},{"name":"Tianjin Key Laboratory of Intelligence Computing and Novel Software Technology Tianjin University of Technology  Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyan","family":"Cui","sequence":"additional","affiliation":[{"name":"Tianjin Central Hospital of Gynecology Obstetrics\/Nankai University Affiliated Maternity Hospital  Tianjin China"},{"name":"Tianjin Key Laboratory of Human Development and Reproductive Regulation  Tianjin China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Lv","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Human Development and Reproductive Regulation  Tianjin 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