Tecnologias de cuidado para prevenção e controle da hemorragia no terceiro estágio do parto: revisão sistemática

Rev. Latino-Am. Enfermagem 2019;27:e3165 DOI: 10.1590/1518-8345.2761.3165 www.eerp.usp.br/rlae Review Article Care technologies to prevent and control hemorrhage in the third stage of labor: a systematic review* Rita de Cássia Teixeira Rangel1,2 https://orcid.org/0000-0001-9713-0220 Maria de Lourdes de Souza1 https://orcid.org/0000-0002-4327-1279 Objective: to identify evidence concerning the contribution of health technologies used to prevent and control hemorrhaging Cheila Maria Lins Bentes1,3 https://orcid.org/0000-0002-9694-9581 Anna Carolina Raduenz Huf de Souza1,4 https://orcid.org/0000-0002-4769-4797 Maria Neto da Cruz Leitão1,5 https://orcid.org/0000-0003-0876-776X Fiona Ann Lynn6 https://orcid.org/0000-0003-4918-6195 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 * Supported by Programa Pesquisa para o SUS (PPSUS), Brasil, grant #TO2016 TR2211 (PPSUS 10/2015) and by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil Finance Code 001. 1 Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil. 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 2 Universidade do Vale do Itajaí, Itajaí, SC, Brazil. 3 Universidade do Estado do Amazonas, Manaus, AM, confirmed in 61.90% of the papers. The levels of evidence Brazil. confirm the contribution of technologies to prevent and control 4 Prefeitura Municipal de Florianópolis, Secretaria Municipal hemorrhaging. Clinical nurses should provide scientific-based de Saúde, Florianópolis, SC, Brazil. 5 Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal. 6 care and develop protocols addressing nursing care actions. Queens University, School of Nursing, Belfast, Northern Descriptors: Postpartum Hemorrhage; Biomedical Technology; Ireland. Disease Prevention; Diffusion of Innovation; Maternal Death; Nursing Care. How to cite this article Rangel RCT, Souza ML, Bentes CML, Souza ACRH, Leitão MNC, Lynn FA. Care technologies to prevent and control hemorrhage in the third stage of labor: a systematic review. Rev. Latino-Am. Enfermagem. 2019;27:e3165. [Access ___ __ ____]; Available in: ___________________. DOI: http://dx.doi.org/10.1590/1518-8345.2761.3165. URL month day year 2 Rev. Latino-Am. Enfermagem 2019;27:e3165. Introduction control of hemorrhaging; personnel of sufficient quality and number to meet demand is necessary. Postpartum hemorrhage (PPH) is one of the Technologies, evidence-based practice, and have grown main causes of maternal morbidity and mortality interventions worldwide(1-2). PPH is defined as blood loss above exponentially in importance from the mid-twentieth 500 ml, measured up to 24 hours postpartum, while century, so much so that providing quality services this amount of blood loss after 24 hours is defined without such resources is inconceivable currently, with as secondary PPH(1,3). Blood loss up to 500ml among many of them being innovative in nature(6). All these healthy women does not lead to negative consequences; aspects a service is required to have are known as however, uncontrolled blood loss over 500ml can be health technologies – a term that encompasses every fatal(1). Primary PPH occurs in the first 24 hours after intervention used to promote health. “In this sense, birth and is more likely to result in maternal morbidity health technologies can be conceived as the practical and mortality, while secondary postpartum hemorrhage application of knowledge, including machines, clinical refers to bleeding that occurs from 24 hours up to six and surgical procedures, medications, programs and weeks after birth(1,3). systems intended to promote health care”(7). proposed by workers In general, blood loss is diagnosed as PPH if one Similarly, the literature presents the elements or more of the following occur: loss of uterine tone that integrate health technologies, namely any and (atony); retention of placental tissue or blood clots; all methods/devices used to promote health, prevent laceration of the genital tract; or coagulopathy(1,3). death, and treat diseases and improve rehabilitation or Procedures to prevent PPH are initiated by assessing the care of individuals or populations(8). a patient’s risk profile and establishing how to respond Traditional product technologies (equipment, drugs to complications in order to prevent a small amount of and material) require intermediate steps with relatively bleeding from becoming a severe hemorrhage with the differentiated processes and actors, although these are risk of death. PPH is one of the complications of the increasingly connected. Note that product technologies third stage of labor and this stage begins after the fetus such as diagnostic or therapeutic resources used in is expelled; however, with the detaching of the placenta healthcare delivery are more effective when combined from the uterine wall and its expulsion through the with process technologies. Process technologies, in birth canal, greater than expected bleeding may occur. turn, include operational procedures, care, education Therefore, it is essential to know the physiology of and management childbirth and women’s clinical conditions, as well as a scientific basis to strengthen healthcare delivery and intercurrences that took place during the pregnancy- produce evidence to innovate in regard to product and puerperal process technologies(9-10). period, which might emergence of hemorrhaging (1,4) contribute to the . techniques. Thus, one should seek There are various systematic reviews addressing In order to prevent PPH, the staff needs to be PPH showing it still accounts for high levels of morbidity prepared to use protocols with a multidisciplinary and mortality, mainly in developing countries. For approach, which involves maintaining hemodynamic this reason, studies need to be conducted regularly, stability while, simultaneously, identifying and treating considering that all technologies should be revised and the cause of bleeding. A combination of prediction and updated over time, especially when we consi (...truncated)