{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:44:47Z","timestamp":1792176287755,"version":"4.4.0"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002842","name":"Chiang Mai University","doi-asserted-by":"publisher","award":["CMU\u20102568"],"award-info":[{"award-number":["CMU\u20102568"]}],"id":[{"id":"10.13039\/501100002842","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":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the association between the duration of the third stage of labor and postpartum hemorrhage (PPH), and to identify an appropriate time threshold for performing manual removal of the placenta (MROP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted in women who underwent vaginal delivery with an uncomplicated third stage of labor. Data were retrieved from a digital obstetric database, including consecutive records of singleton pregnancies delivered vaginally at \u226524\u2009weeks of gestation. Cases with excessive bleeding or emergency placental removal before completion of the third stage were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a 13\u2010year study period, 13\u2009653 cases were eligible for analysis, comprising 13\u2009509 cases managed expectantly and 54 undergoing MROP. The median duration of the third stage was 5\u2009min, and &lt;1% of cases exceeded 40\u2009min. The duration of the third stage was an independent risk factor for increased blood loss (523\u2009\u00b1\u2009376 vs. 239\u2009\u00b1\u2009161\u2009mL after and before 30\u2009min, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), higher PPH rates, and greater need for blood transfusion. When the third stage exceeded 30\u2009min, MROP resulted in significantly greater median blood loss compared with expectant management (500 vs. 400\u2009mL,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018) and a higher rate of PPH (62.96% vs. 38.58%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas the duration of the third stage was significantly shortened (38 vs. 50\u2009min,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Blood loss increased with prolonged third\u2010stage duration, with a markedly higher risk of PPH after 30\u2009min. In cases with an uncomplicated third stage, expectant management is preferable within the first 30\u2009min. Beyond this point, either expectant management or MROP may be considered on an individualized basis, with appropriate preparedness for PPH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71120","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T15:03:12Z","timestamp":1780585392000},"page":"921-929","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between the duration of the third stage of labor and postpartum hemorrhage"],"prefix":"10.1002","volume":"175","author":[{"given":"Kittipat","family":"Tuitemwong","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saipin","family":"Pongsatha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Threebhorn","family":"Kamlungkuea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"},{"name":"Fetal Center, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natnipa","family":"Parapob","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"},{"name":"Fetal Center, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-6478","authenticated-orcid":false,"given":"Theera","family":"Tongsong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"},{"name":"Fetal Center, Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"issue":"6","key":"e_1_2_13_2_1","first-page":"863","article-title":"Prolonged third stage of labor: morbidity and risk factors","volume":"77","author":"Combs CA","year":"1991","journal-title":"Obstet Gynecol"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002351"},{"issue":"7","key":"e_1_2_13_4_1","first-page":"442","article-title":"Postpartum hemorrhage: prevention and treatment","volume":"95","author":"Evensen A","year":"2017","journal-title":"Am Fam Physician"},{"key":"e_1_2_13_5_1","unstructured":"WHO.WHO recommendations for the prevention and treatment of postpartum haemorrhage.2012."},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1552-6909.12528"},{"issue":"2","key":"e_1_2_13_7_1","first-page":"Cd007412","article-title":"Active versus expectant management for women in the third stage of labour","volume":"2","author":"Begley CM","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(95)91493-5"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000151993.83276.70"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001399"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2024.07.019"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12200"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12441"},{"issue":"2","key":"e_1_2_13_14_1","first-page":"S76","article-title":"The duration of the third stage of labor and related factors","volume":"17","author":"Taebi M","year":"2012","journal-title":"Iran J Nurs Midwifery Res"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-025-07229-4"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71120","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.71120","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:49:31Z","timestamp":1792172971000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.71120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1002\/ijgo.71120"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.71120","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]},"assertion":[{"value":"2025-12-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}