Incidence of postpartum hemorrhage in the prolonged second stage of labor: A case series
DOI:
https://doi.org/10.37800/RM.2.2026.750Keywords:
postpartum hemorrhage, prolonged second stage of labor, uterine atony, obstetric complications, blood loss volumeAbstract
Relevance: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide, accounting for up to 27-30% of all maternal deaths. The incidence of PPH ranges from 5-10% of all deliveries, while severe forms with blood loss ≥1000 mL occur in 1-2% of women in labor. A prolonged second stage of labor is considered one of the major risk factors for uterine atony and postpartum hemorrhage, increasing its likelihood by 2-3 times.
The study aimed to assess the frequency of postpartum hemorrhage in cases of prolonged second-stage labor and to determine the relationships among second-stage duration, blood loss volume, and the severity of obstetric complications.
Materials and Methods: A retrospective study of 168 vaginal deliveries was conducted at the Regional Clinical Hospital and Perinatal Center №2 in Karaganda. Two groups were formed: women with a normal second stage of labor (≤60 min) and those with a prolonged second stage (>60 min). The study evaluated blood loss volume, frequency of uterine atony, use of uterotonic agents, obstetric complications, and the need for intensive care. Statistical analysis was performed using Student’s t-test, the χ² test, and odds ratio (OR); statistical significance was set at p < 0.05.
Results: The frequency of PPH ≥500 mL in the prolonged second-stage group was 65.3%, compared with 29.2% in the normal second-stage group (p < 0.001). Massive hemorrhage ≥1000 mL was observed in 25.0% versus 4.2% of cases, respectively (p < 0.001). Uterine atony was identified in 47.2% versus 17.7% (p < 0.001). The risk of postpartum hemorrhage in women with a prolonged second stage of labor increased 4.3-fold (OR 4.30, p < 0.001).
Conclusion: A prolonged second stage of labor is an independent predictor of severe postpartum hemorrhage and requires enhanced prevention strategies and active management of the third stage of labor.
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