{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:23:01Z","timestamp":1790792581950,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,2,14]],"date-time":"2017-02-14T00:00:00Z","timestamp":1487030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2013\u20102429"],"award-info":[{"award-number":["2013\u20102429"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004348","name":"Stockholms L\u00e4ns Landsting","doi-asserted-by":"publisher","award":["ALF project 20130156"],"award-info":[{"award-number":["ALF project 20130156"]}],"id":[{"id":"10.13039\/501100004348","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2017,3]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Prolonged labour is associated with increased risk of postpartum haemorrhage (PPH<\/jats:styled-content>), but the role of active pushing time and the relation with management during labour remains poorly understood.<\/jats:p><\/jats:sec>Methods<\/jats:title>A population\u2010based cohort study from electronic medical record data in the Stockholm\u2010Gotland Region, Sweden. We included 57 267 primiparous women with singleton, term gestation, livebirths delivered vaginally in cephalic presentation in 2008\u201314. We performed multivariable Poisson regression to estimate the association between length of second stage, pushing time, and PPH<\/jats:styled-content> (estimated blood loss >500 mL during delivery), adjusting for maternal, delivery, and fetal characteristics as potential confounders.<\/jats:p><\/jats:sec>Results<\/jats:title>The incidence of PPH<\/jats:styled-content> was 28.9%. The risk of PPH<\/jats:styled-content> increased with each passing hour of second stage: compared with a second stage <1 h, the adjusted relative risk (RR<\/jats:styled-content>) for PPH<\/jats:styled-content> were for 1 to <2 h 1.10 (95% confidence interval (CI<\/jats:styled-content>) 1.07, 1.14); for 2 to <3 h 1.15 (95% CI<\/jats:styled-content> 1.10, 1.20); for 3 to <4 h 1.28 (95% CI<\/jats:styled-content> 1.22, 1.33); and for \u22654 h 1.40 (95% CI<\/jats:styled-content> 1.33, 1.46). PPH<\/jats:styled-content> also increased with pushing time exceeding 30 min. Compared to pushing time between 15 and 29 min, the RR<\/jats:styled-content> for PPH<\/jats:styled-content> were for <15 min 0.98 (95% CI<\/jats:styled-content> 0.94, 1.03); for 30\u201344 min 1.08 (95% CI<\/jats:styled-content> 1.04, 1.12); for 45\u201359 min 1.11 (95% CI<\/jats:styled-content> 1.06, 1.16); and for \u226560 min 1.20 (95% CI<\/jats:styled-content> 1.15, 1.25).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Increased length of second stage and pushing time during labour are both associated with increased risk of PPH<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12344","type":"journal-article","created":{"date-parts":[[2017,2,14]],"date-time":"2017-02-14T14:42:41Z","timestamp":1487083361000},"page":"126-133","source":"Crossref","is-referenced-by-count":35,"title":["Duration of Second Stage of Labour at Term and Pushing Time: Risk Factors for Postpartum Haemorrhage"],"prefix":"10.1111","volume":"31","author":[{"given":"Emelie","family":"Looft","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Unit Department of Medicine Solna Karolinska University Hospital and Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Simic","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit Department of Medicine Solna Karolinska University Hospital and Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia","family":"Ahlberg","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit Department of Medicine Solna Karolinska University Hospital and Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M.","family":"Snowden","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology and Public Health and Preventive Medicine Oregon Health and Science University Portland OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne W.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California at Davis Sacramento CA"},{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology California Pacific Medical Center San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1528-4563","authenticated-orcid":false,"given":"Olof","family":"Stephansson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit Department of Medicine Solna Karolinska University Hospital and Institutet Stockholm Sweden"},{"name":"Division of Epidemiology and Biostatistics School of Public Health University of California Berkeley CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,2,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69380-X"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e3181cc406d"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31822a6c59"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181d74898"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.01.011"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.07.007"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.10.872"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.05.044"},{"key":"e_1_2_7_11_1","first-page":"52","article-title":"Maternal and neonatal outcomes in patients with a prolonged second stage of labor","volume":"102","author":"Myles TD","year":"2003","journal-title":"Obstetrics and Gynecology"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000278"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1992.tb13753.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.08.003"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181a722d6"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767050802676709"},{"key":"e_1_2_7_17_1","first-page":"361","article-title":"When to stop pushing: effects of duration of second\u2010stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia","volume":"201","author":"Ray C","year":"2009","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0142171"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2006.00129.x"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13287"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws127"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01642-8"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182639fae"},{"key":"e_1_2_7_24_1","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/S0301-2115(03)00639-0","article-title":"Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch population\u2010based cohort study on standard (> or = 500 ml) and severe (> or = 1000 ml) postpartum haemorrhage","volume":"115","author":"Bais JM","year":"2004","journal-title":"European Journal of Obstetrics, Gynecology, and Reproductive Biology"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2002.810305.x"}],"container-title":["Paediatric and Perinatal Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fppe.12344","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ppe.12344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T18:55:11Z","timestamp":1695495311000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ppe.12344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,14]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1111\/ppe.12344"],"URL":"https:\/\/doi.org\/10.1111\/ppe.12344","archive":["Portico"],"relation":{},"ISSN":["0269-5022","1365-3016"],"issn-type":[{"value":"0269-5022","type":"print"},{"value":"1365-3016","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,14]]}}}