Care technologies to prevent and control hemorrhage in the third stage of labor: a systematic review.
Rita de Cássia Teixeira Rangel, Maria de Lourdes de Souza, Cheila Maria Lins Bentes and 3 others
PMID 31432919WHAT IT FOUND
Uterotonic drugs, active management and controlled cord traction had evidence to reduce PPH; routine uterine massage, a collection bag and education alone did not help.
Misoprostol was useful where oxytocin was unavailable, but caused more side effects.
Key findings
01Omitting controlled cord traction from active management increased PPH risk, manual placenta removal, blood loss and third-stage duration.
02Misoprostol caused more side effects than oxytocin in most comparisons.
03Uterine massage added to uterotonics did not reduce blood loss and caused pain or discomfort.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Evidence quality varied: among the randomized trials, 14 were high, 12 moderate and 13 low, so not all findings carry the same weight. Most included product technologies were drugs; only two papers covered non-drug products, so evidence on devices is thin. Only eight papers addressed process technologies, so findings on care processes such as massage, cord traction and education are less developed. The search was limited to studies from June 2006 to July 2016 and to Portuguese, Spanish or English papers. Some drug studies had methodological limitations, including lack of blinding in oxytocin studies and low-level evidence for several misoprostol recommendations.
Declared interests
Funded by Programa Pesquisa para o SUS, grant #TO2016 TR2211 (PPSUS 10/2015), and by CAPES, Finance Code 001. No competing-interest declaration is stated.
The easy way to misread this
Do not conclude that routine uterine massage should be added to uterotonics for PPH prevention; in the trial reviewed, massage plus uterotonics did not reduce blood loss compared with uterotonics alone, and women reported pain or discomfort.