MANAGEMENT OF THE POSTPARTUM HEMORRHAGE (IN SPANISH)

Abstract

Introduction: the obstetric hemorrhage is the main cause of maternal death in the world. In Colombia the postpartum hemorrhage is the second cause of deaths associated with the pregnancy. It could be primary (PPH) or secondary. The primary ones appear in the first 24 hours after the birth and are the most frequent. Objective: To identify the etiological factors and the therapeutic proposals for the management of the PPH. Methods: Electronic search was carried out in the databases PubMed, ScienceDirect, EBSCOhost, Ovid and scielo, textbook of obstetric and guidelines for its management published since January, 2005 to December, 2013. Also, in the documents and guidelines of the Ministerio de Salud y Protección Social de Colombia. Results: 52 studies were selected for review and there were chosen 30 that were achieving with the inclusion criteria. Conclusions: The etiological factors are remembered by the mnemonic of the 4Ts (Tonus, trauma, tissue and thrombin). The uterine atony (uterine tonus disorder) is presented in the 80% of the cases and its management consists in uterine massage, Oxytocin, Methylergonovine and Misoprostol use. Between the non-pharmacological measures are cited the bakri balloon, embolization, hypogastric or uterine arteries ligation, B-Lynch´s surgery and subtotal or total abdominal hysterectomy. The other causes of PPH are the injuries of the channel of the childbirth, the retention of remains and the coagulation disorders, that have specific management. The identification of the etiological factors for PPH allows the early standard for the management, which avoids the morbidity and reduces the mortality. It is fundamental the implementation of institutional protocols. Rev.cienc.biomed.2014;5(2):307-316. KEYWORDS Postpartum hemorrhage, Oxytocin, Methylergonovine, Misoprostol

Keywords

• Postpartum hemorrhage
• Oxytocin
• Methylergonovine
• Misoprostol