{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T08:14:52Z","timestamp":1770279292684,"version":"3.49.0"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,8,30]],"date-time":"2018-08-30T00:00:00Z","timestamp":1535587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Jonas Veteran Healthcare Scholar Award"},{"name":"Jonas Foundation"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Postpartum hemorrhage (<jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (<jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content>) for preventing <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>. However, trials of <jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content> include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications. Counseling women about their risk for <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content> is difficult as many women who appear low\u2010risk can still have <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study uses outcomes of 2322 vaginal births from a hospital midwifery service in the United States to examine risks for <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> and effectiveness of <jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content>. Using a latent class analysis approach, physiologic birth practices and other risk factors for <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> were analyzed to understand if discrete classes of clinical characteristics would emerge. The effect of <jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content> on the <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> outcome was also considered by class.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A four\u2010class solution best fit the data; each class was clinically distinct. The two largest Classes (A and B) represented women with term births and lower average parity, with higher rates of nulliparity in Class B. Class A women had more physiologic birth elements and less labor induction or labor dysfunction compared with Class B. <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content> use was higher in Class B. In Class B, <jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content> lowered risk for <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>. However, in Class A, <jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content> was associated with higher risk for <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> and delayed placental delivery (&gt;30\u00a0minutes).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">AMTSL<\/jats:styled-content> may not be as beneficial to women undergoing physiologic birth. Further study of the etiology of <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> in these women is indicated to inform preventive care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12384","type":"journal-article","created":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T03:33:02Z","timestamp":1535686382000},"page":"69-79","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage"],"prefix":"10.1111","volume":"46","author":[{"given":"Elise N.","family":"Erickson","sequence":"first","affiliation":[{"name":"Oregon Health and Science University Portland Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Boston College Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Grose","sequence":"additional","affiliation":[{"name":"Southdale ObGyn Consultants in Edina Edina Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy","family":"Emeis","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University Portland Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,8,30]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"World Health Organization.WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. 2012. 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