Postpartum bleeding prevention, active management in the third stage of labor
Section: Revisions
How to quote
Serrano Alonso I. Prevención de hemorragias en el postparto, manejo activo del alumbramiento. Matronas Hoy 2021; 8(1):37-44.
Authors
Iraia Serrano Alonso
Position
Especialista enfermería obstétrico-ginecológica (matrona)
Contact email: iraia_serrano@yahoo.es
Abstract
Postpartum bleeding prevention, active management in the third stage of labor
Introduction: postpartum bleeding (PPB) refers to any vaginal bleeding > 500 ml after a vaginal delivery or > 1,000 ml after a C-section. PPB is an obstetric emergency that requires multidisciplinary management as well as prevention strategies. The risk of bleeding occurs in the third stage of labor. This stage can be actively managed or a watchful waiting attitude can be adopted.
Purpose: to perform a database search on the different measures employed to prevent postpartum bleeding; to compile the available scientific evidence; and to critically present the conclusions.
Methods: a literature search was carried out in Pubmed, Cochrane, Cuiden, and Dialnet databases.
Results: the efficacy of active management of labor versus spontaneous labor, the use of oxytocin in a managed labor, the umbilical cord drainage maneuver; and the use of misoprostol, methylergometrine, carboprost, carbetocin and syntometrine in the active management are analyzed.
Discussion: according to the retrieved literature, active management is superior to spontaneous delivery in the prevention of PPB. The benefit appears to be driven by the administration of uterotonics as a component of active management. The drug of choice for managed labor is oxytocin, which has been shown to reduce the risk of PPB events larger than 500 cc in several clinical trials. However, for severe PPB (> 1,000 cc), no conclusive evidence is available.
Conclusions: fr the prevention of PPB, active management of labor seems to be the most effective strategy. Although there is no consensus among authors and studies on the route, dosage, and appropriate time for the administration of oxytocin, it is concluded that this drug is effective in preventing postpartum bleeding episodes of more than 500 cc. Misoprostol seems to be less effective than oxytocin. Carboprost could be a more effective alternative to oxytocin, but more studies are needed to draw conclusions. Carbetocin could be an alternative in medium-low resource areas where refrigerators are not available.
Keywords:
postpartum bleeding; prevention; active management of laborobstetric-gynecological nursing
Versión en Español
Título:
Prevención de hemorragias en el postparto, manejo activo del alumbramiento
Artículo completo no disponible en este idioma / Full article is not available in this language
Bibliography
1. Hemorragia postparto precoz. Protocolos SEGO ProgObstetGinecol. 2008; 51:497-505.
2. Organización Mundial de la Salud (OMS). Recomendaciones de la OMS para la prevención y el tratamiento de la hemorragia posparto. Ginebra: OMS; 2014.
3. Gallardo C, Salguero R. Prevención, manejo y cuidados de la hemorragia posparto. Ciberrevista [internet]. 2019 [citado 8 mar 2021]. Disponible en: http://www.enfermeriadeurgencias.com/ciber/noviembre2014/pagina8.html
4. Morillas Salazar R, Iglesias Moya J. Abordaje y plan de cuidados de la hemorragia postparto. Enfermería de urgencias. 2017; 57.
5. Mousa H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database of Systematic Reviews. 2014
6. Ezquerro Cordón V, Gómez Ruiz R, Bonet Pérez B, Salcedo Clemos L, Irache Ferrández A. Manejo del alumbramiento. Resumen de la evidencia. 2016.
7. Manejo de la tercera etapa del parto para evitar una hemorragia posparto. Declaración conjunta de la Confederación Internacional de Matronas (ICM) y la Federación Internacional de Ginecólogos y Obstetras (FIGO). Matronas profesión. 2007; 8:26-7.
8. Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? BJOG: An International Journal of Obstetrics & Gynaecology. 2014; 122(2):202-10.
9. Yildirim D, Ozyurek S, Ekiz A, Eren E, Hendem D, Bafali O, et al. Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial. Ginekologia Polska. 2016; 87(5):399-404.
10. Dupont C, Ducloy-Bouthors A, Huissoud C. Prévention clinique et pharmacologique de l’hémorragie du post-partum lors de la troisième phase du travail. Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 2014; 43(10):966-97.
11. Sentilhes L, Merlot B, Madar H, Sztark F, Brun S, Deneux-Tharaux C. Postpartum haemorrhage: prevention and treatment. Expert ReviewofHematology. 2016; 9(11):1043-61.
12. Vasconcelos F, Katz L, Coutinho I, Lins V, de Amorim M. Placental cord drainage in the third stage of labor: Randomized clinical trial. PLOS ONE. 2018; 13(5):e0195650.
13. Garabedian C, Simon M, Closset E, Ducloy-Bouthors A, Schaffar A, Deruelle P, et al. Systematic prophylactic oxytoci ninjection and the incidence of postpartum hemorrhage: A before-and-after study. Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 2016; 45(2):147-54.
14. Kuzume A, Sugimi S, Suga S, Yamashita H, Yasuhi I. The Routine Use of Prophylactic Oxytocin in the Third Stage of Labor to Reduce Maternal Blood Loss. Journal of Pregnancy. 2017; 1-4. 1.
15. Erickson E, Lee C, Emeis C. Role of Prophylactic Oxytocin in the Third Stageof Labor: Physiologic Versus Pharmacologically Influenced Labor and Birth. Journal of Midwifery & Women' sHealth. 2017; 62(4):418-24.
16. Oladapo O, Okusanya B, Abalos E. Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour. Cochrane Data base of Systematic Reviews. 2018
17. Lojano Gutiérrez MI. Estudio clínico aleatorizado de la eficacia de la oxitocina via cordón umbilical en el manejo activo del tercer período del parto, Hospital Vicente Corral Moscoso, Cuenca- Ecuador. Tesis [internet]. 2014 [citado 8 mar 2021]. Disponible en: http://dspace.ucuenca.edu.ec/handle/123456789/5247
18. Garrigue A, Pierre F. Misoprostol: utilisation hors AMM dans la prise en charge de l’hémorragie du post-partum. Journal of Gynecology Obstetrics and Human Reproduction 2019.
19. Rajaei M, Karimi S, Shahboodaghi Z, Mahboobi H, Khorgoei T, Rajaei F. Safety and Efficacy of Misoprostol versus Oxytocin for the Prevention of Postpartum Hemorrhage. Journal of Pregnancy. 2014; 2014:1-4.
20. Quibel T, Ghout I, Goffinet F, Salomon L, Fort J, Javoise S, et al. Active Management of the Third Stage of Labor With a Combination of Oxytocin and Misoprostol to Prevent Postpartum Hemorrhage. Obstetrics & Gynecology. 2016; 128(4):805-11.
21. Sunil Kumar K, Shyam S, Batakurki P. Carboprost Versus Oxytocin for Active Management of Third Stage of Labor: A Prospective Randomized Control Study. The Journal of Obstetrics and Gynecology of India. 2016; 66(S1):229-34.
22. Theunissen F, Chinery L, Pujar Y. Current research on carbetocin and implications for prevention of postpartum haemorrhage. Reproductive Health. 2018; 15(S1).
23. Widmer M, Piaggio G, Nguyen T, Osoti A, Owa O, Misra S, et al. Heat-StableCarbetocin versus Oxytocint o Prevent Hemorrhage after Vaginal Birth. New England Journal of Medicine. 2018; 379(8):743-52.
