{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:57:26Z","timestamp":1790668646269,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["U01HD077384"],"award-info":[{"award-number":["U01HD077384"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Oxytocin is often used in the second stage of labor and despite studies demonstrating dose\u2010dependent oxytocin receptor desensitization, the relationship between second stage exposure and postpartum hemorrhage (PPH) risk is not well established. We sought to evaluate the relationship between second\u2010stage oxytocin exposure and postpartum bleeding outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Secondary analysis of a multicenter randomized controlled trial of term singleton nulliparous patients with neuraxial analgesia comparing immediate versus delayed pushing in the second stage. Estimated cumulative second\u2010stage oxytocin exposure was calculated as the product of oxytocin dose at complete dilation and second\u2010stage duration and was modeled continuously per 100\u2010milliunit (mU) increase. The primary outcome was a maternal composite consisting of PPH, blood transfusion, or additional uterotonic administration. Modified Poisson regression with robust variance estimation was used to estimate risk ratios (RRs) and adjusted risk ratios (aRRs), controlling for randomized pushing assignment, admission diagnosis, and prolonged second\u2010stage duration. Exploratory analyses evaluated estimated blood loss (EBL) as a continuous outcome; sensitivity analyses examined categorical exposure groups using median cumulative dose defined as no exposure (0 mU), low exposure (&lt;816 mU), and high exposure (\u2265816 mU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2302 participants were included from the parent trial. Each 100\u2010mU increase in estimated second\u2010stage oxytocin exposure was associated with a 2.5% higher risk of the primary maternal composite outcome (aRR, 1.025, 95% confidence interval [CI], 1.014\u20131.036;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and a 2.7% higher risk of PPH (aRR, 1.027, 95% CI, 1.015\u20131.038;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). In exploratory analyses, increasing exposure was associated with greater EBL (aRR, 1.008, 95% CI, 1.006\u20131.010;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Categorical sensitivity analyses demonstrated similar findings, with high exposure associated with a 60% higher risk of the primary maternal composite outcome and a 63% higher risk of PPH compared with no exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Greater cumulative second\u2010stage oxytocin exposure was associated with increased maternal morbidity, particularly postpartum hemorrhage, with findings supporting a dose\u2013response relationship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70467","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:35:33Z","timestamp":1790667333000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between oxytocin exposure in the second stage of labor and postpartum hemorrhage among nulliparous patients with neuraxial analgesia"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2781-6918","authenticated-orcid":false,"given":"Rachel L.","family":"Bank","sequence":"first","affiliation":[{"name":"Department of Women's Health University of Texas at Austin Dell Medical School  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0036-0837","authenticated-orcid":false,"given":"Miriam J.","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Department of Women's Health University of Texas at Austin Dell Medical School  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7655-3013","authenticated-orcid":false,"given":"Sindhu K.","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1752-0972","authenticated-orcid":false,"given":"Aaron B.","family":"Caughey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan T.","family":"Tita","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Center for Women's Reproductive Health at the University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2696-3302","authenticated-orcid":false,"given":"Methodius G.","family":"Tuuli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Warren Alpert Medical School at Brown University, and Women and Infants Hospital of Rhode Island  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Macones","sequence":"additional","affiliation":[{"name":"Department of Women's Health University of Texas at Austin Dell Medical School  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison G.","family":"Cahill","sequence":"additional","affiliation":[{"name":"Department of Women's Health University of Texas at Austin Dell Medical School  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(24)00560\u20106"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1513247"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.04.011"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/GCO.0000000000000776"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.08.023"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogn.2020.08.005"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2024.2369210"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.07.054"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20101786\u20109096"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12344"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010025\u201007229\u20104"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1530\/jrf.0.1200091"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/4.5.625"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.13986"},{"key":"e_1_2_11_16_1","volume-title":"First and Second Stage Labor Management","author":"American College of Obstetricians and Gynecologists","year":"2024"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000134"},{"key":"e_1_2_11_18_1","volume-title":"Postpartum Hemorrhage","author":"American College of Obstetricians and Gynecologists. 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