Hemorragia posparto precoz: actualización de prevención y manejo

Abstract

Early postpartum haemorrhage (early PPH) is defined as blood loss greater than 500 ml in vaginal delivery or greater than 1000 ml in cesarean delivery in the first 24 hours postpartum, or any blood loss after delivery that causes hemodynamic instability.It is considered the main cause of maternal death in the world and in Ecuador it ranks as the second cause of deaths due to postpartum complications, therefore the objective of this bibliographic review is to identify the most effective method for its prevention and management. We searched for randomized clinical trials, metaanalyses, systematic reviews, and other types of studies published in the last 5 years in digital databases such as PubMed, Cochrane Library, and Elsevier. Based on this information, it was obtained that the active management of the third stage of labor is the most effective method of prevention with oxytocin 10 IU IV/IM as first-line uterotonic, although misoprostol, ergotamine and carbetocin are also recommended in special circumstances. Regarding treatment, it was found that oxytocin 10 to 30 IU IV and tranexamic acid 1 g IV within the first 3 hours of the onset of bleeding were similarly effective in reducing blood loss. Thus, it is concluded that oxytocin is the most effective uterotonic agent for prevention and both it and tranexamic acid have been shown to be effective in the management of early PPH.