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Subject Area

Radiology

Article Type

Original Study

Abstract

Objective The aim of this study was to estimate the specific duration of the third stage of labor (TSL) above which the risk of increased maternal blood loss occurs. The primary outcome included the correlation between duration of the TSL and vaginal blood loss during the third stage and postpartum hemorrhage (PPH). Secondary outcomes included required blood transfusion, amount of ecbolics used during the third stage, analgesics used during labor, and neonatal outcome parameters. Background The practice of removing placentas that have not been spontaneously expelled within 30 min of delivery has been poorly evaluated; therefore, the purpose of this study was to estimate the most specific cutoff time of the TSL at which the palcenta should be removed to prevent further blood loss and in turn PPH. Materials and methods This cross-sectional study was carried out at the Department of Obstetrics and Gynecology at Dekernis General Hospital after obtaining approval from the Medical Ethics Committee for Human Research, from March 2014 to December 2015. The study included 600 women during their TSL. Informed consent was obtained from all participants. We calculated the duration of the TSL using a stopwatch from the time of delivery of the neonate until the delivery of the placenta. The amount of blood lost during the TSL was calculated using graduated collection containers and leather sheets designed for vaginal deliveries. Results The receiver operating characteristic curve of the duration of the TSL and the amount of third-stage blood loss detected a cutoff duration of 18 min, at which the risk of PPH increased with a sensitivity of 36.8% and a specificity of 93.6%; at this point, the false-positive result was 6.4% only. Conclusion The duration of the TSL is shorter in a modern obstetric cohort relative to historically reported norms. In term, vaginal deliveries, duration of the TSL of greater than 18 min was associated with increased risk of PPH.

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