{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:08:07Z","timestamp":1792098487125,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T00:00:00Z","timestamp":1697328000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The impact of first stage labour duration on maternal outcomes is sparsely investigated. We aimed to study the association between a longer active first stage and maternal complications in the early postpartum period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A population\u2010based cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Regions of Stockholm and Gotland, Sweden, 2008\u20132020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A cohort of 159\u2009459 term, singleton, vertex pregnancies, stratified by parity groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The exposure was active first stage duration, categorised in percentiles. Poisson regression analysis was performed to estimate the adjusted relative risk (aRR) and the 95% confidence interval (95%\u2009CI). To investigate the effect of second stage duration on the outcome, mediation analysis was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Severe perineal lacerations (third or fourth degree), postpartum infection, urinary retention and haematoma in the birth canal or ruptured sutures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The risks of severe perineal laceration, postpartum infection and urinary retention increased with a longer active first stage, both overall and stratified by parity group. The aRR increased with a longer active first stage, using duration of &lt;50th percentile as the reference. In the \u226590th percentile category, the aRR for postpartum infection was 1.64 (95%\u2009CI 1.46\u20131.84) in primiparous women, 2.43 (95%\u2009CI 1.98\u20132.98) in parous women with no previous caesarean delivery (CD) and 2.33 (95%\u2009CI 1.65\u20133.28) in parous women with a previous CD. The proportion mediated by second stage duration was 33.4% to 36.9% for the different outcomes in primiparous women. The risk of haematoma or ruptured sutures did not increased with a longer active first stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increasing active first stage duration is associated with maternal complications in the early postpartum period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17692","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T04:58:52Z","timestamp":1697432332000},"page":"832-842","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Duration of the active first stage of labour and severe perineal lacerations and maternal postpartum complications: a population\u2010based cohort study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5612-9872","authenticated-orcid":false,"given":"Lisa","family":"Kogner","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Division, Department 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