Fármacos alternativos na profilaxia de hemorragia pós-parto no cenário de contenção da ocitocina sintética – uma revisão integrativa de literatura

Abstract

In Brazil, postpartum hemorrhage (PPH) is the second leading cause of maternal death in the world. As a prophylactic measure, synthetic oxytocin is used in all parturients in the third stage of labor, because it helps in uterine contraction avoiding PPH. However, in 2022, the possibility of shortages of this uterotonic was announced. In view of this, some hospitals had to develop a contingency plan and resort to alternative prophylaxis in the management of postpartum hemorrhage, aiming to provide qualified care to the parturient. Objective: To identify evidence available in the literature regarding alternative prophylactic measures to oxytocin in the management of primary postpartum hemorrhage. Materials and methods: This is an integrative review, with a descriptive approach and a qualitative character, following the PRISMA model, in which studies carried out between 2018-2023, available in the following databases: SciELO, Capes Journals and Virtual Health Library (VHL), and published in English, Spanish and Portuguese, were selected. The PICO strategy was used to formulate the guiding question and select descriptors, in addition to the use of the Boolean operators AND and OR, as well as filters, in order to make the searches more restricted to the topic in question. Results: After the selection of the studies and data extraction, the final analysis was performed. Initially, the equivalent of 10,503 studies were found in the databases, but only 30 were eligible to read the abstracts. In the end, only 11 articles met the inclusion criteria and were included in this study. Discussion: The results of this review showed that the drugs misoprostol, carbetocin, ergometrine, methylergometrine, prostaglandins or tranexamic acid are effective alternative therapies for the management of PPH in women and that they can be used to replace oxytocin in cases of probable shortage. Of these drugs, carbetocin was shown to be one of the most effective as a prophylactic measure of PPH individually. In addition, the synergistic use of drugs may be more effective in preventing PPH than necessarily isolated use. Not only the use of drugs, but also the use of ergot alkaloids, the use of technologies, improvement and qualification of professionals, as well as active management can help in the prophylaxis of PPH. Conclusion: alternative management involving the use of uterotonic drugs, use of product and process technologies, active management of professionals and resource management are effective alternative measures in PPH prophylaxis.