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INTRODUCTION: Literature supports numerous benefits of skin-to-skin contact for neonatal adaptation to extrauterine life and bonding/attachment, but few studies explore the effects of skin-to-skin contact on maternal outcomes. This review aims to map the evidence on skin-to-skin contact in the third stage of labor for postpartum hemorrhage prevention. METHODS: Scoping review, which covered stages recommended by the Institute Joanna Briggs, including studies from the PubMed, EMBASE, CINAHL, LILACS, Web of Science, and Scopus databases, using the descriptors "Postpartum hemorrhage", "Labor stages, third", "Prevention" and "Kangaroo care/Skin-to-skin". RESULTS: 100 publications on the subject found, 13 articles met the inclusion criteria, with 10,169 dyads were assessed in all studies. Publications from 2008 to 2021 were mostly written in English and designed as a randomized controlled trial. Skin-to-skin contact was effective and significant in: reducing the duration of the third stage of labor; placenta delivery; uterine contractility and physiological involution; absence of atony, decreasing blood loss with lower rates of erythrocyte and hemoglobin drop; reducing the need for synthetic oxytocin and/or ergometrine to control bleeding; and reducing changing pads per period and length of stay. DISCUSSION: Skin-to-skin contact was considered an effective, low-cost, and safe strategy, with positive effects already established in the literature for infants and extremely favorable results in postpartum hemorrhage prevention cases, being highly recommended in assistance for the dyad. Open Science Framework Registry ( https://osf.io/n3685 ).

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OBJECTIVES: Assess the effects of different routes of prophylactic oxytocin administration for preventing blood loss at caesarean section (CS). DESIGN: Systematic review and meta-analysis. METHODS: Medline, EMBASE, CINAHL, Cochrane Library, BVS, SciELO and Global Index Medicus were searched through 24 May 2020 for randomised controlled trials (RCTs) comparing different routes of prophylactic oxytocin administration during CS. Study selection, data extraction and quality assessment were conducted by two investigators independently. We pooled results in fixed effects meta-analyses and calculated average risk ratio (RR), mean difference (MD) and 95% CI. We used GRADE to assess the overall quality of evidence for each outcome. RESULTS: Three trials (180 women) were included in the review. All studies compared intramyometrial (IMY) versus intravenous oxytocin in women having prelabour CS. IMY compared with intravenous oxytocin administration may result in little or no difference in the incidence of postpartum haemorrhage (RR 0.14, 95% CI 0.01 to 2.70; N=100 participants; 1 RCT), hypotension (RR 1.00, 95% CI 0.29 to 3.45; N=40; 1 RCT), headache (RR 3.00, 95% CI 0.13 to 69.52; N=40; 1 RCT) or facial flushing (RR 0.50, 95% CI 0.05 to 5.08; N=40; 1 RCT); IMY oxytocin may reduce nausea/vomiting (RR 0.13, 95% CI 0.02 to 0.69; N=140; 2 RCTs). We are very uncertain about the effect IMY versus intravenous oxytocin on the need for additional uterotonics (RR 0.82; 95% CI 0.25 to 2.69; N=140; 2 RCTs). IMY oxytocin may reduce blood loss slightly (MD -57.40 mL, 95% CI -101.71 to -13.09; N=40; 1 RCT). CONCLUSIONS: There is limited, low to very low certainty evidence on the effects of IMY versus intravenous oxytocin at CS for preventing blood loss. The evidence is insufficient to support choosing one route over another. More trials, including studies that assess intramuscular oxytocin administration, are needed on this relevant question. PROSPERO REGISTRATION NUMBER: CRD42020186797.

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BACKGROUND: Medical management of retained placenta could be a safe alternative to manual removal. OBJECTIVE: To evaluate the efficacy of prostaglandin analogues for retained placenta. SEARCH STRATEGY: MEDLINE, EMBASE, CENTRAL, ICTRP, LILACS, and OpenSIGLE were searched without language restrictions from inception to January 31, 2017, by combining terms for retained placenta and prostaglandin analogues. SELECTION CRITERIA: Randomized controlled trials comparing prostaglandin analogues with any other intervention. DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion, data extraction, and risk of bias. Data were extracted for meta-analyses. GRADE was used to evaluate the quality of data. MAIN RESULTS: Seven randomized controlled trials (851 patients) were included. Prostaglandins did not increase the placenta expulsion rate (relative risk [RR] 1.40, 95% confidence interval [CI] 0.83-2.36) or decrease maternal transfusion (RR 0.72, 95% CI 0.43-1.22). In comparison with oxytocin, prostaglandins did not modify the expulsion rate (RR 1.26, 95% CI 0.90-1.78), maternal transfusion (RR 1.05, 95% CI 0.27-4.09), or time for delivery of placenta (mean difference -1.56 minutes, 95% CI, -9.25-6.13). Three trials comparing prostaglandins with oxytocin agonists, ergometrine, and manual removal reported similar results. CONCLUSIONS: Prostaglandin analogues do not offer an effective alternative for management of retained placenta.

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OBJECTIVES: a) To compare the clinical effect of rectal misoprostol with intramuscular syntometrine in reducing blood loss in the third stage of labour, b) to determine the severity and incidence of side effects of both drugs and c) to measure blood loss, patient tolerance and acceptance of rectal misoprostol. METHODS: One hundred and forty parturients were randomly allocated to receive intramuscular syntometrine (syntocinon 10 IU + ergometrine 0.5 mg) or rectal misoprostol 400 ?g within five minutes of the delivery of the anterior shoulder. Blood loss was measured by the use of a plastic collection drape. Additional oxytocic therapy was instituted for uterine atony or if blood loss was in excess of one litre. RESULTS: There was no significant difference in patient demographics of each treatment group (Table 1). There was no difference in mean duration of the third stage of labour (8.4 ± 14 min vs 7.8 ± 6.6 min). The mean blood loss from those parturients receiving misoprostol (180.1 ± 120 mls) was not significantly different (p = 0.5) from those receiving syntometrine (197 ± 176.97 mls) for the active management of the third stage of labour. Treatment with syntometrine was associated with a significant elevation of post-partum systolic blood pressure compared with misoprostol treatment (mean increase 0.57 ± 18.79 mmHg vs -1.43 ± 14.17 mmHg, (mean ± SD), p < 0.04). Rectal misoprostol was well tolerated in 88.5% of participants, 11.4% reported that insertion was uncomfortable, of which 2.8% reported that they would have preferred parenteral drug administration. CONCLUSION: The clinical effect of rectal misoprostol and intramuscular syntometrine were not different at the doses used in the active management of the third stage of labour in this study. Rectal misoprostol was well tolerated by the patients and had a low side effect profile. Blood loss assessment using the blood collection drape is of invaluable benefit in resource-poor settings.

OBJETIVOS: a) Comparar el efecto clínico del misoprostol rectal con la sintometrina intramuscular en la reducción de la pérdida de sangre en la tercera etapa del parto, b) determinar la severidad y la incidencia de los efectos colaterales de ambos medicamentos, y c) medir la pérdida de sangre, la tolerancia de las pacientes y la aceptación del misoprostol rectal. MÉTODOS: Ciento cuarenta parturientas fueron elegidas de forma aleatoria para que recibieran la sintometrina intramuscular (syntocinon 10 IU + ergometrina 0.5 mg) o el misoprostol rectal 400 µg dentro de los cinco minutos de la salida del hombro anterior. Se midió la pérdida de sangre usando una bolsa plástica de recolección de sangre. Se instituyó una terapia oxitócica adicional para la atonía uterina o para el caso de que la pérdida de sangre excediera un litro. RESULTADOS: No hubo diferencia significativa en la demografía de los pacientes de cada grupo de tratamiento (tabla 1). No hubo diferencia en la duración promedio de la tercera etapa del parto (8.4 ± 14 min vs 7.8 ± 6.6 min). La pérdida promedio de sangre de las parturientas que recibieron el misoprostol (180.1 ± 120 mls) no fue significativamente diferente (p = 0.5) de las que recibieron sintometrina (197 ± 176.97 mls) para el tratamiento activo de la tercera etapa del parto. El tratamiento con sintometrina estuvo asociado con una elevación significativa de la presión sistólica postparto comparada con el tratamiento con misoprostol (aumento promedio 0.57 ± 18.79 mmHg vs -1.43 ± 14.17 mmHg, (media ± sd), p < 0.04). El misoprostol rectal fue bien tolerado por el 88.5% de las participantes, 11.4% reportaron que la inserción fue incómoda, y de ellas 2.8% reportó que hubieran preferido una administración parenteral del medicamento. CONCLUSIÓN: El efecto clínico del misoprostol rectal y el de la sintometrina intramuscular, no fueron diferentes en las dosis usadas en el tratamiento activo de la tercera etapa del parto en este estudio. El misoprostol rectal fue bien tolerado por las pacientes y tuvo un perfil de efecto colateral bajo. La evaluación de la pérdida de sangre utilizando una bolsa de recolección de sangre posee un valor inapreciable en escenarios de recursos pobres.

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OBJECTIVES: a) To compare the clinical effect of rectal misoprostol with intramuscular syntometrine in reducing blood loss in the third stage of labour b) to determine the severity and incidence of side effects of both drugs and c) to measure blood loss, patient tolerance and acceptance of rectal misoprostol. METHODS: One hundred and forty parturients were randomly allocated to receive intramuscular syntometrine (syntocinon 10 IU + ergometrine 0.5 mg) or rectal misoprostol 400 microg within five minutes of the delivery of the anterior shoulder Blood loss was measured by the use of a plastic collection drape. Additional oxytocic therapy was instituted for uterine atony or if blood loss was in excess of one litre. RESULTS: There was no significant difference in patient demographics of each treatment group (Table 1). There was no difference in mean duration of the third stage of labour (8.4 +/- 14 min vs 7.8 +/- 6.6 min). The mean blood loss from those parturients receiving misoprostol (180.1 +/- 120 mls) was not significantly different (p = 0.5) from those receiving syntometrine (197 +/- 176.97 mls) for the active management of the third stage of labour Treatment with syntometrine was associated with a significant elevation of post-partum systolic blood pressure compared with misoprostol treatment (mean increase 0.57 +/- 18.79 mmHg vs -1.43 +/- 14.17 mmHg, (mean +/- SD), p < 0.04). Rectal misoprostol was well tolerated in 88.5% of participants, 11.4% reported that insertion was uncomfortable, of which 2.8% reported that they would have preferred parenteral drug administration. CONCLUSION: The clinical effect of rectal misoprostol and intramuscular syntometrine were not different at the doses used in the active management of the third stage of labour in this study. Rectal misoprostol was well tolerated by the patients and had a low side effect profile. Blood loss assessment using the blood collection drape is of invaluable benefit in resource-poor settings.

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Aborda un estudio de tipo experimental realizado en el servicio de Labor y Parto del Hospital Escuela "Oscar Danilo Rosales" en el período de septiembre 2002 y enero 2003, a todas las pacientes que acudian al servicio y que presentaban trabajo de parto. El universo de estudio estuvo constituido por 62 paciente las que presentaban las siguientes características: Bajo riesgo para la presentación de hemorragia postparto, de estas 24 fueron incluidas en el grupo que no recibirían manejo activo del tercer período del trabajo de parto y las 38 restantes en el grupo que si lo recibirían. Estos grupos de estudios se distribuyeron según grupo de edad y paridad tanto las de manejo activo del alumbramiento, como las sin manejo activo del alumbramiento. En el estudio se determinó la duración del trabajo de parto según la paridad de la paciente, en el grupo de las que recibieron manejo activo, así mismo se hizó con las sin manejo activo del alumbramiento. En relación con la variación en el hematocrito encontrado en el postparto y comparado con el encontrado en el ingreso de la paciente se observa que en el grupo de pacientes que recibieron manejo activo del alumbramiento no hubo variación mayor del 3 porciento en el hatocrito de control de ninguna de las pacientes que no recibieron el manejo activo del alumbramiento, el 25 porciento de las pacientes presentaron variación mayor a 3 porciento en el hematocrito de control lo que hace suponere una perdida de sangre de más de 500 cc durante el trabajo de parto (cantidad considerada como máximo normal en un trabajo de parto sin complicaciones

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Se describe el tratamiento eléctrico y mecánico (balón hemostático intrauterino MMP) de un útero atónico que no respondió a la terapia habitual de masajes, ocitócicos, metilergonovina y prostaglandina E. La utilización del balón hemostático intrauterino MMP, permitió el cese inmediato del sangrado. De manera complementaria se procedió a la desfibrilación uterina externa, la cual permitió la contracción definitiva del útero atónico

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