Risk Factors for Hemorrhage in The Third Stage of Labor: A Systematic Review Protocol

Abstract

BackgroundPostpartum hemorrhage (PPH) is the most common form of obstetric hemorrhage. This is the main cause of maternal death around the world: the incidence varies among countries and accounts for 27% (in some countries, more than 50%) of direct obstetric maternal deaths, mainly in the postpartum period. Recognizing risk factors for PPH in prenatal care and during childbirth care is the first stage to prevent maternal death from PPH. The objective this review is: To identify the risk factors for hemorrhage in the third stage of labor described in the literature from 2000 to 2020. MethodsA protocol for a Systematic Review and Meta-analysis study was developed, supported by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and, registered in the International Prospective Register of Systematic Reviews (PROSPERO). The research question for conducting the review was structured according to the PEOS strategy (P — Populations/People/Patient/ Problem, E — Exposure (s), O — Outcome, S — Study design): P — women aged from 10 to 49 years, in labor; E — risk factors for hemorrhage in the third stage of labor; O — women with hemorrhage during birth and postpartum; S — observational studies (case control and cohort). Thus, the defined question was: what are the risk factors for hemorrhage in the third stage of labor described in the literature from 2000 to 2020? As for the planning of electronic searches, databases were consulted by using the platform of the Coordination for the Improvement of Higher Education Personnel in Brazil (CAPES, as per its Portuguese acronym). Due to the characteristics of each database, specific search strategies were chosen for each database. After applying the eligibility criteria, the articles that are selected will have the quality of the evidence evaluated by applying the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), with the online tool GRADEpro GDT.Discussion Prevention and control of hemorrhage must be initiated in the prenatal period, requiring competent professionals to carry out the appropriate clinical evaluation to classify the degree of risk to which the woman is exposed. This systematic review will support the studies of professionals who working in Angola and Brazil.Systematic review registrationPROSPERO available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021219303