Abstract
Objective to identify evidence concerning the contribution of health technologies used to prevent and control hemorrhaging in the third stage of labor.Method systematic review with database searches. First, two researchers independently selected the papers and, at a second point in time, held a reconciliation meeting. The Kappa coefficient was used to assess agreement, while the Grading of Recommendations, Assessment, Development and Evaluation was adopted to assess risk of bias and classify level of evidence.Results in this review, 42 papers were included, 34 of which addressed product technologies, most referred to pharmacological products, while two papers addressed the use of blood transparent plastic bags collector and the contribution of birth spacing and prenatal care. The eight papers addressing process technologies included the active management of the third stage of labor, controlled cord traction, uterine massage, and educational interventions.Conclusion product and process technologies presented high and moderate evidence confirmed in 61.90% of the papers. The levels of evidence confirm the contribution of technologies to prevent and control hemorrhaging. Clinical nurses should provide scientific-based care and develop protocols addressing nursing care actions.
Highlights
Postpartum hemorrhage (PPH) is one of the main causes of maternal morbidity and mortality worldwide(1-2)
Primary PPH occurs in the first 24 hours after birth and is more likely to result in maternal morbidity and mortality, while secondary postpartum hemorrhage refers to bleeding that occurs from 24 hours up to six weeks after birth(1,3)
It is based on this assumption that we present evidence reported by the 42 studies that make up this systematic review: 33 of these analyzed the efficacy of uterotonic drugs to prevent/treat PPH, including studies addressing oxytocin, misoprostol, ergometrine, syntometrine, carbetocin, PGF2α and
Summary
Postpartum hemorrhage (PPH) is one of the main causes of maternal morbidity and mortality worldwide(1-2). PPH is defined as blood loss above 500 ml, measured up to 24 hours postpartum, while this amount of blood loss after 24 hours is defined as secondary PPH(1,3). Primary PPH occurs in the first 24 hours after birth and is more likely to result in maternal morbidity and mortality, while secondary postpartum hemorrhage refers to bleeding that occurs from 24 hours up to six weeks after birth(1,3). Blood loss is diagnosed as PPH if one or more of the following occur: loss of uterine tone (atony); retention of placental tissue or blood clots; laceration of the genital tract; or coagulopathy(1,3). It is essential to know the physiology of childbirth and women’s clinical conditions, as well as intercurrences that took place during the pregnancypuerperal period, which might contribute to the emergence of hemorrhaging(1,4)
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