Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews

Abstract

BackgroundPostpartum haemorrhage is a direct cause of maternal death worldwide and usually occurs during the third stage of labour. Most women receive some type of prophylactic management, which may include pharmacological or non-pharmacological interventions. The objective of this study was to summarize systematic reviews that assessed the effects of postpartum haemorrhage prophylactic management during the third stage of labour.MethodsWe applied the guidelines for conducting an overview of reviews from the Cochrane Handbook for Systematic Reviews of Interventions. We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews to identify all relevant systematic reviews of randomized controlled trials of prophylactic management of postpartum haemorrhage in the third stage of labour compared with no treatment, placebo, or another management technique. Two review authors independently extracted data and assessed methodological quality using a measurement tool to assess reviews and quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation for primary outcomes, summarizing results narratively.ResultsWe identified 29 systematic reviews: 18 Cochrane and 11 non-Cochrane. Cochrane systematic reviews were high quality, while the quality of non-Cochrane systematic reviews varied. The following techniques suggested effective, third-stage interventions to reduce the incidence of severe postpartum haemorrhage: active management of the third stage of labour compared to physiological management, active management compared to expectant management, administration of oxytocin compared to placebo, and use of tranexamic acid compared to placebo. The following third-stage management approaches reduced the need for blood transfusion: active management compared to physiological management, active management compared to expectant management, oral misoprostol compared to placebo, and tranexamic acid compared to placebo.ConclusionsNo effective prophylactic management techniques were identified for maternal mortality. Most methods of effective prophylactic management of postpartum haemorrhage were supported by evidence; however, they were limited to low- or moderate-quality evidence, and high-quality studies are therefore needed. Outcome measures of the included systematic reviews varied. It is recommended that outcome measures in preventive postpartum haemorrhage intervention trials align with the World Health Organization guidelines.Systematic review registrationPROSPERO: CRD42016049220.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0817-3) contains supplementary material, which is available to authorized users.

A review of postpartum hemorrhage in low‐income countries and implications for strengthening health systems

“…42 When AMSTL was first described, it included administration of a prophylactic uterotonic, early cord clamping, controlled cord traction, and uterine massage. 42 The most important action in AMSTL is the administration of a prophylactic uterotonic drug. As compared with placebo, prophylactic uterotonics significantly decrease the percentage of women who lose more than 500 ml of blood.…”

Anais Do 1º Congresso Internacional Multiprofissional Em Atenção Primária À Saúde

“…Além de ter o conhecimento técnico-científico, o profissional precisa conseguir aplicar e realizar os manejos adequadamente, dentre tantas intervenções, é salutar realizar manejo ativo no terceiro estágio do trabalho de parto (MASUZAWA et al, 2018). Ademais, implementar uma séria de medidas para realizar o controle e tratamento, que podem ser não farmacológicas, como a massagem uterina, tamponamento uterino com balão de Bakri, compressão bimanual, manobras com cordão umbilical e com o útero, manobra de Brandt-Andrews.…”

“…Além dessas medidas farmacológicas são empregadas, o uso de uterotônicos para controle da perda sanguínea, como ocitocina, ergometrina, carbetocina, ácido tranexâmico e misoprostol compreendendo administração de cada um (CASTEBLANCO et al, 2022;OLIVEIRA et al, 2019). A administração de misoprostol, apresenta algumas divergências, mesmo sendo a principal escolha a ser administrada em situações de partos no ambiente domiciliar de forma oral (ABBAS et al, 2020), a maior parte das pacientes que recebem essa droga são encaminhadas para o serviço especializado e recebem doses de outros uterotônicos por via parenteral, sobretudo a ocitocina (ABBAS et al, 2020;MASUZAWA et al, 2018). Contudo, no atendimento domiciliar o misoprostol é uma alternativa promissora (ABBAS et al, 2020).…”

Physiology and Pathology of Contractility of the Myometrium

“…Despite its extensive use and the fact that more than two-thirds of deliveries are vaginal births, the optimal dose-regimen or even if a higher oxytocin dose could be more effective in vaginal deliveries is not known. Thus, considering vaginal delivery, no specific oxytocin dose is related to lower risk for PPH (58)(59)(60)(61).…”