Tranfusion risk: is 'two-step' vaginal delivery a risk for postpartum hemorrhage?

Abstract Objective: In the active management strategy of third stage of labur, the optimal timing for clamping the umbilical cord after birth has been a subject of controversy. We want to evaluate if 'two-step' delivery is a risk factor for postpartum haemorrhage, defined as need of transfusion, comparing to operative delivery, elective caesarean delivery and emergency caesarean delivery. Methods: this is a retrospective cohort study conducted in division of Perinatal Medicine, Policlinico Abano Terme. We evaluated the need of transfusion in all cases of postpartum hemorrhage verified in all single deliveries between January 2011 and December 2012. The main outcome measure was blood loss and red blood cell transfusion Results: We found 17 cases of postpartum haemorrhage (0.88%). The distribution of PPH in relation to mode of delivery was 0.71%, 2.46% and 1.98% respectively for two step vaginal delivery (RR=0.81 (0.56-1.22)), emergency cesarean section (RR=2.88 (1.27-7.77)) and operative vaginal delivery (RR=2.88 (0.59-5.66)). In labor induction there is a stronger relative risk association between postpartum hemorrhage and as emergency cesarean delivery (p<0.05) as operative vaginal delivery (p<0.05). Conclusion: "two-step" delivery approach did not increase the risk of postpartum hemorrhage with respect to operative delivery, elective caesarean section, and emergency caesarean section.