Especificidades técnicas no tamponamento uterino com balões e algumas dificuldades técnicas / Technical specificities in uterine tamponade with balloons and some technical difficulties

A mortalidade materna é inaceitavelmente alta. A hemorragia pós-parto encontra- se na primeira posição no mundo, tendo como principal causa específica a atonia uterina. Eventualmente, as medidas iniciais e a terapia farmacológica não são efetivas no controle do sangramento, impondo a necessidade de tratamentos invasivos, cirúrgicos ou não. Entre esses, o tamponamento uterino com balão requer recursos locais mínimos e não exige treinamento extensivo ou equipamento muito complexo. Entretanto, algumas dificuldades podem ocorrer durante a inserção, infusão ou manutenção do balão na cavidade uterina, com especificidades relacionadas à via de parto. Após o parto vaginal, a dificuldade mais prevalente é o prolapso vaginal do balão. Na cesárea, as principais dificuldades são a inserção e o posicionamento do balão na cavidade uterina, principalmente nas cesáreas eletivas. Este artigo revisa e ilustra as principais dificuldades e especificidades relacionadas ao tamponamento uterino com balões.

Maternal mortality is unacceptably high. Postpartum hemorrhage is ranked first in the world, with the main specific cause being uterine atony. Eventually, initial measures and pharmacological therapy are not effective in controlling bleeding, imposing the need for invasive treatments, surgical or not. Among these, uterine balloon tamponade requires minimal local resources and does not require extensive training or very complex equipment. However, some difficulties may occur during insertion, infusion, or maintenance of the balloon in the uterine cavity, with specificities related to the mode of delivery. After vaginal delivery, the most prevalent difficulty is vaginal balloon prolapse. In cesarean section, the main difficulty is the insertion and positioning of the balloon in the uterine cavity, especially in elective cesarean sections. This article reviews and illustrates the main difficulties and specificities related to uterine balloon tamponade.

Uso de misoprostol em obstetrícia / Misoprostol use in obstetrics

PONTOS-CHAVE O misoprostol é um análogo da prostaglandina E1 (PGE1) que consta na Lista de Medicamentos Essenciais da Organização Mundial da Saúde (OMS) desde 2005 O Brasil possui uma das regulações mais restritivas do mundo relacionadas ao uso do misoprostol, estabelecendo que o misoprostol tem uso hospitalar exclusivo, com controle especial, e venda, compra e propaganda proibidas por lei Atualmente, o misoprostol é a droga de referência para tratamento medicamentoso nos casos de aborto induzido, tanto no primeiro trimestre gestacional quanto em idades gestacionais mais avançadas O misoprostol é uma medicação efetiva para o preparo cervical e indução do parto O misoprostol é um medicamento essencial para o manejo da hemorragia pós-parto

Resultados de la estrategia de código rojo en la atención a pacientes con hemorragia posparto / Results of the red code strategy in the care of patients with postpartum hemorrhage

Introducción: La estrategia de código rojo permite la atención inmediata, sistematizada y coordinada de la hemorragia posparto. Es un esquema de trabajo organizado que contribuye a un tratamiento oportuno y pertinente de la hemorragia obstétrica. Con esta herramienta, el equipo asistencial puede seguir los pasos indicados sin desviarse del objetivo, trabajar de manera ordenada y aplicarlo en cada situación específica, para disminuir la morbilidad y mortalidad materna. Objetivo: Caracterizar los resultados de la estrategia de código rojo en la atención a pacientes con hemorragia posparto en Villa Clara. Métodos: Se realizó un estudio de desarrollo, observacional, de corte transversal y retrospectivo de las pacientes con hemorragia posparto en Villa Clara, durante el período de enero 2018 a junio de 2021. La muestra no probabilística quedó conformada por 127 pacientes. Se utilizaron medidas de resumen para la descripción de las variables. En las cuantitativas se emplearon medidas de tendencia central y de dispersión (media y desviación estándar), para las variables cualitativas se mostraron frecuencias absolutas y relativas. Para establecer las relaciones entre variables se aplicó la prueba de independencia basada en la distribución Ji cuadrado. Resultados: En la evaluación del cumplimiento del protocolo de código rojo resultaron incorrectos algunos parámetros como: el diagnóstico de las etapas del choque y el tiempo de accionar. Conclusiones: Cada institución debe contar con protocolos y guías de atención de pacientes obstétricas con bases científicas que se correspondan a las posibilidades de cada país; estos protocolos deben facilitar y perfeccionar las acciones del médico.

Introduction: the red code strategy allows immediate, systematized and coordinated care of postpartum hemorrhage. It is an organized work scheme that contributes to timely and relevant treatment of obstetric hemorrhage. The healthcare team can follow with this tool the indicated steps without deviating from the objective, work in an orderly manner and apply it in each specific situation to reduce maternal morbidity and mortality. Objective: to characterize the results of the red code strategy in the care of patients with postpartum hemorrhage in Villa Clara. Methods: a retrospective, cross-sectional, observational and developmental study was carried out in patients with postpartum hemorrhage in Villa Clara from January 2018 to June 2021. The non-probabilistic sample consisted of 127 patients. Summary measures were used to describe the variables. Measures of central tendency and dispersion (mean and standard deviation) were used in the quantitative variables as well as absolute and relative frequencies were shown for the qualitative ones. The independence test based on the Chi-square distribution was applied to establish the relationships between variables. Results: some parameters were incorrect in the evaluation of compliance with the red code protocol such as the diagnosis of the stages of shock and the time to act. Conclusions: each institution must have protocols and guidelines for the care of obstetric patients with scientific bases that correspond to the possibilities of each country; these protocols should facilitate and improve the doctor's actions.

Retrospective analysis of associated factors and adverse pregnancy outcomes of postpartum hemorrhage in the caesarean section of different types of placenta previa / 中华预防医学杂志

Objective: To analyze associated factors and adverse pregnancy outcomes of postpartum hemorrhage in the caesarean section of puerperae with different types of placenta previa. Methods: This retrospective research was a case-control study. Puerperae with cesarean section of placenta previa from January 2019 to December 2020 in Women's Hospital, School of Medicine, Zhejiang University were collected and divided into the<1 000 ml control group or ≥1 000 ml postpartum hemorrhage group according to the amount of blood loss during cesarean section. Differences in continuous variables were analyzed by t-test and categorical variables were analyzed by χ2 test. The risk factors of postpartum hemorrhage were analyzed by logistic multivariate regression. Results: A total of 962 puerperae were enrolled with 773 cases in the control group and 189 cases in the postpartum hemorrhage group. The incidence of gestational weeks, gravidity, parity, induced abortion, placental accreta and preoperative hemoglobin<110 g/L was significantly different between two groups in different types of placenta previa (P<0.001). Logistic multivariate regression model analysis showed that the independent risk factors of postpartum hemorrhage in the caesarean section of low-lying placenta included placental accreta (OR=12.713, 95%CI: 4.296-37.625), preoperative hemoglobin<110 g/L (OR=2.377, 95%CI: 1.062-5.321), and prenatal vaginal bleeding (OR=4.244, 95%CI: 1.865-9.656). The independent risk factors of postpartum hemorrhage in the caesarean section of placenta previa included once induced abortion (OR=2.789, 95%CI:1.189-6.544), induced abortion≥2 (OR=2.843, 95%CI:1.101-7.339), placental accreta (OR=6.079, 95%CI:3.697-9.996), HBsAg positive (OR=3.891, 95%CI:1.385-10.929), and placental attachment to the anterior uterine wall (OR=2.307, 95%CI:1.285-4.142). The rate of postpartum hemorrhage and premature delivery in puerperae with placenta previa was higher than that in puerperae with low-lying placenta (P<0.001). Conclusions: The associated factors of postpartum hemorrhage in puerperae with different types of placenta previa are different. Placenta accreta is the common risk factor of postpartum hemorrhage in puerperae with low-lying placenta and placenta previa.

Fetal Macrosomia and Postpartum Hemorrhage in Latin American and Caribbean Region: Systematic Review and Meta-analysis / Macrossomia fetal e hemorragia pós-parto na região da América Latina e Caribe: Revisão sistemática e metanálise

Abstract Objective To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. Data Sources Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. Selection of Studies Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. Data Collection Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. Data Synthesis Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79-2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40-6.48; I2: 91.89%), showing high heterogeneity. Conclusion There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.

Resumo Objetivo Determinar a associação entre macrossomia fetal (FM) e hemorragia pós-parto (HPP) em mulheres da América Latina e Caribe (ALC). Fontes de dados Estudos avaliando a associação entre FM e HPP (≥ 500 ml) e HPP grave (≥ 1.000 ml) até 4 de novembro de 2021, indexados no CINHAL, Scopus, Embase, Biblioteca Cochrane, MEDLINE, LILACS e SciELO. Seleção de estudos Os critérios de inclusão foram estudos de corte e caso-controle que forneceram o número de casos de HPP e FM. Os critérios de exclusão foram estudos sem informação sobre o número de casos, com uma população de mulheres que não eram da ALC; publicado em um idioma diferente do inglês, espanhol ou português e com um design diferente. Coleta de dados A extração de dados foi realizada independentemente por dois autores, as discrepâncias foram resolvidas com um terceiro autor. Os dados relativos aos casos de FM e HPP foram recuperados. Síntese dos dados Dos 1.044 artigos avaliados, foram incluídos 5 estudos, de 6 países diferentes: Argentina e Uruguai (multipaíses), Índias Ocidentais, Antígua e Barbuda, Guiana Francesa e Suriname. O odds ratio agrupado (OR) para FM e HPP na meta-análise (cinco estudos) foi de 2,10 (intervalo de confiança de 95% [IC]: 1,79-2,47; I2: 0%), com estimativas dentro deste IC de 95% no análise sensitiva. O OR combinado para HPP grave (3 estudos) foi de 1,61 (95% CI: 0.40-6.48; I2: 91.89%), mostrando alta heterogeneidade. Conclusão Houve associação positiva entre FM e HPP na ALC, aumentando em 2 vezes o risco da presença desse evento. A alta heterogeneidade dos estudos que mediram a HPP grave não permite tirar conclusões sobre as estimativas obtidas.

Quality assessment of mobile applications on postpartum hemorrhage management / Evaluación de la calidad de aplicaciones móviles en el manejo de la hemorragia posparto / Avaliação da qualidade de aplicativos móveis sobre o manejo da hemorragia pós-parto

ABSTRACT Objective: To assess mobile application quality on the management of postpartum hemorrhage available in the digital stores of the main operating systems. Method: A descriptive evaluative study, carried out from January to February 2023 on the App Store® and Google Play Store®. The Mobile Application Rating Scale was used to assess quality (engagement, functionality, aesthetics, information and subjective quality). Information extraction and assessment on postpartum hemorrhage was carried out using a table with information based on official documents, containing stratification, prevention, diagnosis and treatment. Results: Seven applications were included; of these, three were in English, six had an Android operating system. The quality mean was 3.88. The highest means were for functionality, reaching 5.0 (n = 6), and the lowest were for engagement, less than 3.0 (n = 4). The majority of applications presented less than 50% of the information on postpartum hemorrhage management. Conclusion: The applications assessed achieved an acceptable quality mean and, according to health organizations' current protocols, did not contain the necessary information for complete postpartum hemorrhage management.

RESUMEN Objetivo: Evaluar la calidad de las aplicaciones móviles sobre el manejo de la hemorragia posparto disponibles en las tiendas digitales de los principales sistemas operativos. Método: Estudio de evaluación descriptivo, realizado de enero a febrero de 2023 en las tiendas digitales App Store® y Google Play Store®. Se utilizó la Escala de Calificación de Aplicaciones Móviles para evaluar la calidad (compromiso, funcionalidad, estética, información y calidad subjetiva). La extracción y evaluación de la información sobre la hemorragia posparto se realizó mediante una tabla con información basada en documentos oficiales, que contiene clasificación, prevención, diagnóstico y tratamiento. Resultados: Se incluyeron siete aplicaciones; de ellos, tres estaban en inglés, seis tenían sistema operativo Android. El promedio de calidad fue 3,88. Los promedios más altos fueron para la funcionalidad, alcanzando 5,0 (n = 6), y los más bajos fueron para el compromiso, menos de 3,0 (n = 4). La mayoría de las solicitudes presentaron menos del 50% de la información sobre el manejo de la hemorragia posparto. Conclusión: Las aplicaciones evaluadas alcanzaron un promedio de calidad aceptable y, según los protocolos vigentes de las organizaciones de salud, no contenían la información necesaria para el manejo completo de la hemorragia posparto.

RESUMO Objetivo: Avaliar a qualidade dos aplicativos móveis sobre o manejo da hemorragia pós-parto disponíveis nas lojas digitais dos principais sistemas operacionais. Método: Estudo descritivo de avaliação, realizado de janeiro a fevereiro de 2023 nas lojas digitais App Store® e Google Play Store®. Foi utilizada a Mobile Application Rating Scale para avaliação da qualidade (engajamento, funcionalidade, estética, informação e qualidade subjetiva). A extração e a avaliação das informações sobre hemorragia pós-parto foram realizadas a partir de um quadro com informações baseadas em documentos oficiais, contendo a classificação, prevenção, diagnóstico e tratamento. Resultados: Sete aplicativos foram incluídos; desses, três estavam em inglês, seis tinham sistema operacional Android. A média de qualidade foi de 3,88. As maiores médias foram da funcionalidade, alcançando 5,0 (n = 6), e as menores foram de engajamento, menos que 3,0 (n = 4). A maioria dos aplicativos apresentou menos de 50% das informações sobre o manejo de hemorragia pós-parto. Conclusão: Os aplicativos avaliados alcançaram média de qualidade aceitável e, conforme os protocolos vigentes das organizações de saúde, não continham as informações necessárias para o manejo completo da hemorragia pós-parto.

Analysis of the efficacy of prophylactic tranexamic acid in preventing postpartum bleeding: systematic review with meta-analysis of randomized clinical trials

Abstract Background Postpartum Hemorrhage (PPH) is one of the main causes of maternal mortality, mainly in the poorest regions of the world, drawing attention to the need for strategies for preventing it. This study aims to evaluate the efficacy of prophylactic administration of Tranexamic Acid (TXA) in decreasing blood loss in pregnant women in delivery, preventing PPH. Methods Systematic review of randomized clinical trials. We searched for publications in PubMed, EMBASE and Cochrane Library databases, with the uniterms "postpartum, puerperal hemorrhage" and "tranexamic acid", published between January of 2004 and January of 2020. The eligibility criteria were trials published in English with pregnant women assessed during and after vaginal or cesarean delivery about the effect of prophylactic use of TXA on bleeding volume. The random-effects model was applied with the DerSimonian-Laird test and the Mean Difference (MD) was calculated for continuous variables together with each 95% CI. This systematic review was previously registered in the PROSPERO platform under the registration n° CRD42020187393. Results Of the 630 results, 16 trials were selected, including one with two different doses, performing a total of 6731 patients. The intervention group received a TXA dose that varied between 10 mg.kg−1 and 1g (no weight calculation). The TXA use was considered a protective factor for bleeding (MD: -131.07; 95% CI: -170.00 to -92.78; p= 0.000) and hemoglobin variation (MD: -0.417; 95% CI: -0.633 to -0.202; p= 0.000). In the subgroup analysis related to the cesarean pathway, the effect of TXA was even greater. Conclusion The prophylactic use of tranexamic acid is effective in reducing the post-partum bleeding volume. PROSPERO registration ID CRD42020187393.

Balões de tamponamento intrauterino na hemorragia pós-parto ­ Atualizações / Uterine balloon tamponade in postpartum hemorrhage ­ Updates

A hemorragia pós-parto continua sendo uma condição relacionada a elevada morbimortalidade materna, sendo essenciais o diagnóstico precoce e o início do tratamento farmacológico. Em caso de falha, os balões de tamponamento uterino são uma alternativa eficiente, com aplicabilidade crescente na prática clínica. Esses dispositivos são seguros, apresentam baixa incidência de eventos adversos e reduzem as taxas de procedimentos cirúrgicos. Existe uma ampla variedade de modelos, tanto industriais quanto artesanais, com acúmulo de relatos na literatura demonstrando sua eficácia. Este artigo descreve os principais balões intrauterinos, com ênfase nos modelos mais novos, aplicabilidade, taxas de sucesso e eventos adversos.(AU)

Postpartum hemorrhage continues to be a condition related to high maternal morbimortality, early diagnosis and initiation of pharmacological treatment are essential. In case of failure, uterine balloon tamponade is an efficient alternative, with increasing applicability in clinical practice. These devices are safe, have a low incidence of adverse events and reduce the overall rates of surgical procedures. There is a wide variety of models, both industrial and artisanal, with an accumulation of reports in the literature demonstrating their effectiveness. This article describes the main intrauterine balloons, with an emphasis on newer models, applicability, success rates and adverse events.(AU)

Attempted vaginal birth after cesarean: assessment of morbidity and predictors of success / Parto tras cesárea anterior: análisis de la morbimortalidad materno-fetal

Objective: Determining the appropriate approach for delivery after previous cesarean is a very controversial issue. Our objective was to establish whether pregnant women with a previous cesarean have an increased maternal and fetal morbidity and mortality after attempting vaginal delivery as well as to determine which factors may influence the achievement of a vaginal birth after cesarean. Materials and methods: A retrospective observational cohort study including 390 patients (196 cesarean group and 194 nulliparous group) was carried out. We compared neonatal and maternal outcomes between groups. Afterward, a multivariate logistic regression was applied for our second objective. Results: There were higher rates of uterine rupture (2% vs. 0%, p: 0.045) and puerperal hemorrhage (9.7% vs. 3.1%, p: 0.008) in the cesarean group and lower vaginal delivery rate (58.2% vs. 77.8%, p < 0.0005). We found that the induced onset of labor (OR = 2.9) and new born weight (OR = 1.0001) were associated with an increased risk of cesarean section. Conclusions: Our findings stress the need for further investigations in this field, which might provide a basis for a better management of patients with a previous cesarean.

Objetivo: Determinar el abordaje adecuado del tipo de parto tras una cesárea previa es un tema muy controvertido. Nuestro objetivo fue establecer si las gestantes con cesárea previa presentan mayor morbimortalidad materna y fetal tras intentar parto vaginal, así como determinar qué factores pueden influir en conseguir un parto vaginal posterior a la cesárea. Material y métodos: Estudio observacional de cohortes retrospectivo incluyendo 390 pacientes (196 con cesárea previa, 194 nulíparas). Comparamos los datos sobre los resultados neonatales y maternos. Posteriormente se aplicó un modelo de regresión logística multivariante. Resultados: Hubo mayores tasas de ruptura uterina (2% vs. 0%; p = 0.045) y hemorragia puerperal (9.7% vs. 3.1%, p: 0.008) en el grupo de cesárea anterior, así como una tasa de parto vaginal mas baja (58.2% vs. 77.8%, p < 0.0005). La inducción del parto (OR = 2,9) y el peso del recién nacido (OR = 1.0001) se asociaron a un mayor riesgo de cesárea. Conclusión: La probabilidad de parto vaginal en estas pacientes disminuye cuanto mayor sea el peso del recién nacido y con partos inducidos.

Necrosis uterina tras sutura de compresión hemostática: reporte de caso y revisión de la literatura / Uterine necrosis following hemostatic compression suture: case report and review of the literature

Objetivos: presentar un caso de necrosis uterina tras técnica de sutura hemostática por hemorragia posparto y hacer una revisión de la literatura para determinar la técnica de sutura utilizada, los hallazgos clínicos, la técnica diagnóstica y el tratamiento realizado en los casos clínicos descritos. Materiales y métodos: se presenta el caso de una mujer de 34 años que consultó por dolor abdominal al octavo día tras cesárea por placenta previa, que precisó sutura de B-Lynch por atonía uterina y cuyo diagnóstico fue necrosis uterina. La paciente requirió histerectomía abdominal total, con evolución satisfactoria. Se realizó una búsqueda sistemática de la literatura en las bases de datos Medline vía Pubmed, Embase y Web of Science. Se buscaron series y reportes de casos y cohortes de mujeres con necrosis uterina posterior al uso de suturas de compresión uterina para control de hemorragia posparto. Se analizaron variables sociodemográficas y clínicas al diagnóstico, técnica de sutura, pruebas diagnósticas y tratamiento. Resultados: se incluyeron 23 estudios con 24 pacientes. El 83 % de las necrosis ocurrieron tras cesárea. La técnica más utilizada fue B-Lynch (66 %), seguida de Cho (25 %). Los síntomas más frecuentes fueron fiebre y dolor abdominal. La prueba diagnóstica más utilizada fue la tomografía computarizada (9 de 24 casos). En la mayoría de casos se realizó histerectomía (75 %). Conclusiones: la necrosis de la pared uterina es una complicación infrecuente pero grave. Sería recomendable el diseño de cohortes de seguimiento de mujeres sometidas a estos procedimientos para determinar la incidencia de complicaciones asociadas.

Objectives: To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described. Materials and Methods: A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment. Results: Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %). Conclusions: Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.

Hemorragia postparto: intervenciones y tratamiento del profesional de enfermería para prevenir shock hipovolémico / Postpartum hemorrhage: Nursing interventions and management to prevent hypovolemic shock

Introducción: En Colombia la hemorragia postparto es la segunda causa de mortalidad en mujeres gestantes de 24 a 34 años con 6,9 casos por cada 1000 nacidos vivos. Después del parto se prevé que el 8.2% de las mujeres latinoamericanas presentarán hemorragia postparto. Objetivo: Describir el cuidado de enfermería a mujeres que presentan hemorragia postparto para disminuir el riesgo de shock hipovolémico, a través de una revisión integrativa de la literatura. Metodología: Revisión integrativa de la literatura siguiendo la propuesta por Sasso, de Campos y Galvão, se realizó una búsqueda en ClinicalKey, LILACS, CINAHL, Epistemonikos, Cochrane Library, PubMed, Scielo y Google Scholar; se incluyeron artículos publicados en los últimos cinco años, en español, inglés y portugués, se clasificaron por nivel de evidencia y grado de recomendación. Esta investigación es de bajo riesgo por ser de tipo documental. Resultados: Se recopilaron 41 artículos definitivos. La información se organizó en: cuadro clínico, cuidados de enfermería y dificultades en la atención gineco-obstétrica. Discusión: El profesional de enfermería debe identificar barreras en la atención evaluando la capacidad resolutiva de las instituciones y analizando los casos de muerte materna. Se recomienda el uso de misoprostol con oxitocina o únicamente de carbetocina y la combinación de ergometrina con oxitocina según el volumen de sangrado. Conclusión: Es pertinente realizar un examen físico para reconocer signos de inestabilidad hemodinámica, y de shock hipovolémico. Además, los diagnósticos e intervenciones de enfermería se enfocan en brindar cuidados de calidad, para evitar complicaciones como la muerte.

Introduction: In Colombia, postpartum hemorrhage is the second leading cause of death in pregnant women at a rate of 6.9 deaths per 1,000 live births. After childbirth, 8.2% of Latin American women are expected to have postpartum hemorrhage. Objective: To describe nursing care delivered to women with postpartum hemorrhage to reduce the risk of hypovolemic shock by means of an integrative literature review. Materials and Methods: Following the approach suggested by Sasso, de Campos and Galvão, an integrative literature review was conducted on ClinicalKey, LILACS, CINAHL, Epistemonikos, Cochrane Library, PubMed and ScieELO Google Scholar databases. Articles published in the last five years in Spanish, English and Portuguese were selected and classified by their level of evidence and degree of recommendation. This is a low-risk research due to its documentary nature. Results: 41 articles were finally selected and classified into clinical picture, nursing care and challenges in OBGYN care. Discussion: Nursing professionals should identify barriers to care by evaluating institutional problem-solving capacity and analyzing maternal death cases. Using misoprostol and oxytocin or only carbetocin and ergometrine-oxytocin is suggested based on the quantity of blood loss. Conclusions: Performing a physical examination is important to recognize signs of hemodynamic instability and hypovolemic shock. Nursing diagnoses and interventions focus on providing quality patient care to prevent certain complications such as death.

Introdução: Na Colômbia, a hemorragia pós-parto é a segunda principal causa de mortalidade em mulheres grávidas de 24-34 anos, com 6,9 casos por 1000 nascidos vivos. Após o parto, 8,2% das mulheres latino-americanas devem sofrer de hemorragia pós-parto. Objetivo: Descrever os cuidados de enfermagem a mulheres com hemorragia pós-parto para reduzir o risco de choque hipovolêmico, através de uma revisão integrativa da bibliografia. Metodologia: Revisão integrativa da bibliografia seguindo a proposta de Sasso, de Campos e Galvão, foi realizada uma pesquisa em ClinicalKey, LILACS, CINAHL, Epistemonikos, Cochrane Library, PubMed, Scielo e Google Scholar; foram incluídos artigos publicados nos últimos cinco anos em espanhol, inglês e português, classificados por nível de evidência e grau de recomendação. Esta é uma pesquisa de baixo risco, pois é do tipo documental. Resultados: Foram recolhidos 41 artigos definitivos. A informação foi organizada em: quadro clínico, cuidados de enfermagem e dificuldades nos cuidados gineco-obstetrítricos. Discussão: O profissional de enfermagem deve identificar as barreiras ao cuidado, avaliando a capacidade das instituições e analisando os casos de morte materna. O uso de misoprostol com ocitocina, ou carbetocina isoladamente, e a combinação de ergometrina com ocitocina são recomendados dependendo do volume de sangramento. Conclusão: O exame físico para sinais de instabilidade hemodinâmica e choque hipovolêmico é relevante. Além disso, os diagnósticos e intervenções de enfermagem concentram-se na prestação de cuidados de qualidade para evitar complicações como a morte.

Redução da mortalidade materna: expectativa de novas estratégias / Reduction of maternal mortality - expectation of new strategies

A morte materna é aquela que acontece em qualquer mulher em estado gravídico, parturiente ou em período puerperal até 42 dias após o parto por qualquer causa de óbito, exceto causas acidentais ou incidentais, ou por causas obstétricas diretas e indiretas ocorrida até 364 dias após o fim da gestação (BROWN , 2022). Em 2019, a taxa de mortalidade materna (TMM) em Goiás foi de 69,7 por 100 mil nascidos vivos (BRASIL, 2021), estando no limiar da meta estabelecida pela Organização Mundial de Saúde no Objetivo de Desenvolvimento Sustentável 3.1, que é de 70 óbitos por 100 mil nascidos vivos (OMS, 2022). No entanto, a frequência absoluta de óbitos maternos no ano de 2021 teve um incremento de 83,5% em relação ao ano de 2019, tornando-se uma preocupação de saúde pública (SECRETARIA DE VIGILÂNCIA EM SAÚDE, 2022)

Maternal death is one that occurs in any pregnant, parturient or puerperal woman up to 42 days after delivery from any cause of death, except accidental or incidental causes, or from direct and indirect obstetric causes occurring up to 364 days after the birth. end of pregnancy (BROWN , 2022). In 2019, the maternal mortality rate (MMR) in Goiás was 69.7 per 100,000 live births (BRAZIL, 2021), being on the threshold of the goal established by the World Health Organization in the Objective of Sustainable Development 3.1, which is 70 deaths per 100,000 live births (WHO, 2022). However, the absolute frequency of maternal deaths in 2021 increased by 83.5% compared to 2019, making it a public health concern (SECRETARIA DE SURVEILLANCE IN HEALTH, 2022)

Efectividad de las sesiones demostrativas para mejorar el conocimiento en la prevención de la anemia en gestantes, madres lactantes De niños menores de 3 años. Centro de salud Aparicio Pomares. Huánuco ­ perú / Effectiveness of demonstration sessions to improve knowledge in the prevention of anemia in pregnant women, nursing mothers of children under 3 years. Aparicio pomares health center. Huánuco ­ Peru

El problema de la anemia está muy relacionado a los índices de pobreza, falta de cuidado de la salud y educación de la población, pero principalmente a la falta de conocimientos sobre alimentación y nutrición infantil por parte de las madres. Objetivo: Determinar la efectividad de las sesiones demostrativas para mejorar el conocimiento en la prevención de la anemia en gestantes, madres lactantes de niños menores de 3 años. Materiales y Métodos: El estudio fue de tipo experimental, descriptivo y de nivel observacional, explicativo y analítico. La población de estudio estuvo conformada por 200 gestantes, obteniendo una muestra de 30 gestantes y 20 madres lactantes de niños menores de 3 años, haciendo un total de 50 pacientes, se utilizó el cuestionario para la recolección de datos, aplicado en dos momentos; antes y después de las sesiones demostrativas, con la finalidad de comparar los resultados. Resultados: El nivel de conocimiento teórico de las madres, luego de la aplicación de las sesiones demostrativas se incrementó su nivel a un conocimiento alto. Respecto a los conocimientos prácticos luego de la aplicación de las sesiones, se logró un conocimiento alto. Conclusiones: La técnica de sesiones demostrativas en el incremento de conocimientos es efectiva(AU)

The problem of anemia is closely related to the rates of poverty, lack of care of the health and education of the population, but mainly to the lack of knowledge about food and infant nutrition by mothers. Objective: To determine the effectiveness of the demonstration sessions to improve knowledge in the prevention of anemia in pregnant women, nursing mothers of minor children 3 years old Materials and methods: The study was of type, experimental, descriptive and observational level, explanatory and analytical. The study population consisted of 200 pregnant women, obtaining a sample of 30 pregnant women and 20 lactating mothers of children under 3 years of age, making a total of 50 patients, the questionnaire was used for data collection, applied in two moments; before and after demonstration sessions, in order to compare the results. Results: The level of theoretical knowledge of the mothers, after the application of the demonstrative sessions their level to high knowledge. Regarding the practical knowledge after the application of the sessions, high knowledge was achieved. Conclusions: The technique of demonstrative sessions in the increase of knowledge is effective(AU)

Intra-abdominal aortic balloon occlusion in the management of placenta percreta / 中华医学杂志(英文版)

BACKGROUND@#Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients.@*METHODS@#We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed.@*RESULTS@#One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2 = 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2 = 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P = 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t = -0.638, P = 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups.@*CONCLUSIONS@#IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.

An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to the High Dependency Care Unit at Women and Newborn Hospital, Lusaka-Zambia

Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Acretismo placentário e suas complicações / Placental accretism and its complications

Acretismo é um termo genérico que significa uma invasão trofoblástica anormal da placenta em parte ou, mais raramente, na totalidade do miométrio, podendo inclusive chegar à serosa. Esse evento ocorre mais comumente em uma região de cicatriz uterina prévia, onde há um defeito na decidualização. A principal consequência disso é a necessidade frequente de histerectomia puerperal, acarretando grande morbidade materna. Este artigo apresenta o caso de uma gestante com placenta percreta, com acometimento vesical e de colo uterino que necessitou de histerectomia total. Além disso, no pós-operatório, apresentou fístula vesicoabdominal. O objetivo deste artigo é demonstrar as complicações do acretismo placentário e as maneiras de tentar reduzi-lo. O aumento nas proporções de nascimentos via parto cesariana, sem que haja evidências claras de que isso interfira na queda da mortalidade e/ou morbidade materna e neonatal, sugere que estejam sendo indicadas muito mais cesarianas que o necessário. Para redução nas taxas de cesariana e, consequentemente, das complicações dela, como nos casos de acretismo, é necessário repensar a cultura do cuidado da prática clínica em obstetrícia.(AU)

Accretism is a generic term that means an abnormal trophoblastic invasion of the placenta in part or, more rarely, in the entire myometrium, which may even reach the serosa. This event most commonly occurs in a region of previous uterine scar, where there is a decidualization defect. The main consequence of this is the frequent need for puerperal hysterectomy, causing great maternal morbidity. This article presents the case of a pregnant woman with placenta percreta, with bladder and uterine cervix involvement, who required hysterectomy. In addition, postoperatively, presented a vesico-abdominal fistula. The purpose of this article is to demonstrate the complications of placental accretism and ways to try it. The increase in the proportion of births via cesarean delivery, without clear evidences that this interferes with the decrease in maternal and neonatal mortality and/or morbidity, suggests that much more cesarean sections are being indicated than necessary. To reduce cesarean rates and consequently, its complications, as in cases of accretism, it is necessary to rethink the culture of care in clinical practice in obstetrics.(AU)

Condições potencialmente ameaçadoras à vida no ciclo gravídico-puerperal / Condiciones potencialmente amenazantes para la vida en el ciclo gravídico puerperal / Potentially life-threatening conditions determinants in pregnancy-puerperal cycle

ABSTRACT Objetivo: Descrever as principais condições potencialmente ameaçadoras à vida de mulheres durante o ciclo gravídico e puerperal e variáveis relacionadas a esses agravos. Método: Estudo do tipo documental, descritivo e quantitativo, realizado com prontuários de gestantes, parturientes e puérperas internadas em hospital de média complexidade, que apresentaram Condições Potencialmente Ameaçadoras à Vida (CPAV). Foram excluídos os de acesso impossibilitado por estarem sob judice. A amostra foi temporal e a análise univariada. Resultados: Inclui-se 181 prontuários. A maioria das condições ocorreu em mulheres de 16 a 34 anos de idade (61,3%), união estável (60,8%), pardas (31,5%), sem renda ocupacional (29,2%), multíparas (28,87%), com complicações no primeiro trimestre gestacional (32,6%). Verificaram-se a realização de um número insuficiente de consultas (13,8%), dados referentes ao pré-natal ignorados (68%). As principais CPAV foram as síndromes hemorrágicas (28,2%), hipertensivas (25,4%) e infecção (13,3%). Como desfecho, foram observados prevalência de aborto não especificado (22,1%), morte perinatal por doença infecciosa e parasitária da mãe (2,2%). Conclusão: As principais CPAV foram as síndromes hemorrágicas, hipertensivas e infecções. Como desfecho, foram observados alta hospitalar, aborto, referenciamento à UTI, morte perinatal e morte materna.

RESUMEN Objetivo: describir las principales condiciones potencialmente amenazantes para la vida de las mujeres durante el ciclo gravídico y puerperal, además de las variables relacionadas con estos agravios. Método: estudio del tipo documental, descriptivo y cuantitativo, realizado con registros médicos de gestantes, parturientes y puérperas internadas en hospital de mediana complejidad, que presentaron Condiciones Potencialmente Amenazantes a la Vida (CPAV). Se excluyeron los de acceso imposibilitado por estar bajo juicio. La muestra fue temporal y el análisis univariado. Resultados: se incluyen 181 registros médicos. La mayoría de las condiciones ocurrió en mujeres de 16 a 34 años de edad (61,3%), unión estable (60,8%), pardas (31,5%), sin ingreso ocupacional (29,2%), multíparas (28,87%), con complicaciones en el primer trimestre gestacional (32,6%). Se constató un número insuficiente de consultas (13,8 %), datos relativos al prenatal ignorados (68 %). Las principales CPAV fueron los trastornos hemorrágicos (28,2%), hipertensivos (25,4%) e infecciosos (13,3%). Como resultado, se observaron: prevalencia de aborto no especificado (22,1%), muerte perinatal por enfermedad infecciosa y parasitaria de la madre (2,2%). Conclusión: las principales CPAV fueron los trastornos hemorrágicos, hipertensivos e infecciones. Como resultado, se observó alta hospitalaria, aborto, referencia a la UCI, muerte perinatal y muerte materna.

ABSTRACT Objective: To describe the main conditions potentially threatening the lives of women during the pregnancy and puerperal cycle and variables related to these diseases. Method: Documentary, descriptive and quantitative study, conducted with medical records of pregnant women, women giving birth and puerperal women hospitalized in a hospital of medium complexity, who presented Potentially Life Threatening Conditions (PLTC). Those with access unable to be sob judice were excluded. The sample was temporal and the analysis was univariate. Results: This includes 181 medical records. Most conditions occurred in women aged 16 to 34 years (61.3%), stable union (60.8%), brown (31.5%), without occupational income (29.2%), multiparous (28.87%), with complications in the first gestational trimester (32.6%). There was an insufficient number of consultations (13.8%), data regarding prenatal care ignored (68%). The main CPAV were hemorrhagic syndromes (28.2%), hypertensive (25.4%) and infection (13.3%). As an outcome, we observed a prevalence of unspecified miscarriage (22.1%), perinatal death from infectious and parasitic disease of the mother (2.2%). Conclusion: The main CPAV were hemorrhagic, hypertensive and infections syndromes. As an outcome, hospital discharge, miscarriage, ICU referral, perinatal death and maternal death were observed.

Cuidados de enfermeiros frente às hemorragias puerperais: revisão integrativa / Cuidados de enfermeros frente a las hemorragias puerperales: revisión integrativa / Nursing care against puerperal hemorrhages: integrative review

Objetivo: identificar os cuidados de enfermeiros frente às hemorragias puerperais disponíveis na literatura científica. Método: revisão integrativa cuja busca foi realizada nas fontes de informação National Library of Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature Scopus, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Scientific Electronic Library Online. Resultados: foram encontrados 31 cuidados para manejo das hemorragias puerperais, sendo os principais a aferição dos sinais vitais e a nova tecnologia para mensuração sanguínea Quantitative Blood Loss. Evidenciaram-se a falta da verificação dos sinais vitais e registro incorreto dos casos que evoluíram para hemorragia pós-parto. Conclusão: a hemorragia pós-parto pode ser prevenida por meio de cuidados realizados pelos enfermeiros. É necessário que sejam feitos estudos sobre a avaliação do globo de segurança de Pinard, amamentação e vínculo mãe e bebê. E que novas tecnologias, como a quantificação sanguínea, sejam acrescentadas em protocolos institucionais.

Objective: to identify the care of nurses in the face of puerperal hemorrhages available in the scientific literature. Method: integrative review whose search was performed in the sources of information National Library of Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences and Scientific Electronic Library Online. Results: 31 precautions were found for the management of puerperal hemorrhages, the main ones being the measurement of vital signs and the new technology for blood measurement Quantitative Blood Loss. There was a lack of verification of vital signs and incorrect recording of cases that evolved into postpartum hemorrhage. Conclusion: postpartum hemorrhage can be prevented by nursing care. It is necessary that studies be made on the evaluation of the safety globe of Pinard, breastfeeding and mother and baby bond. And those new technologies, such as blood quantification, be added in institutional protocols.

Objective: to identify the care of nurses in the face of puerperal hemorrhages available in the scientific literature. Method: integrative review whose search was performed in the sources of information National Library of Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences and Scientific Electronic Library Online. Results: 31 precautions were found for the management of puerperal hemorrhages, the main ones being the measurement of vital signs and the new technology for blood measurement Quantitative Blood Loss. There was a lack of verification of vital signs and incorrect recording of cases that evolved into postpartum hemorrhage. Conclusion: postpartum hemorrhage can be prevented by nursing care. It is necessary that studies be made on the evaluation of the safety globe of Pinard, breastfeeding and mother and baby bond. And those new technologies, such as blood quantification, be added in institutional protocols.

Rotura uterina: da suspeita ao tratamento / Uterine rupture: from suspicion to treatment

A rotura uterina durante a gravidez ou trabalho de parto é uma grave complicação obstétrica ainda responsável por elevada morbimortalidade materna e perinatal. É importante o diagnóstico diferencial de outras hemorragias da segunda metade da gravidez, como o descolamento prematuro da placenta e a placenta prévia. O diagnóstico é feito baseado em uma associação de sinais bem comuns da rotura uterina. O tratamento sempre é cirúrgico, mas varia de acordo com a classificação da emergência. A prevenção é realizada por meio da atenção obstétrica cuidadosa e com implementação das boas práticas de assistência ao parto.(AU)

Uterine rupture during pregnancy or labor is a serious obstetric complication still responsible for high maternal and perinatal morbidity and mortality. Differential diagnosis of other hemorrhages in the second half of pregnancy, such as placental abruption and placenta previa, is important. The diagnosis is made based on an association of very common signs of uterine rupture. Treatment is always surgical but varies according to the classification of the emergency. Prevention is carried out through careful obstetric care and the implementation of good childbirth care practices.(AU)