RESUMO
La hemorragia puerperal produce el incremento en el número de ingresos en las unidades de cuidados intensivos, que a su vez requiere de una mayor y mejor atención por parte del personal de enfermería. Este trabajo tiene como objetivo, reflexionar sobre los principales elementos a tener en cuenta para el cuidado de enfermería de puérperas con hemorragia, en el contexto de la unidad de cuidados intensivos. El plan de cuidados en puérperas con hemorragia debe estar basado en los diagnósticos de enfermería, que logren un enfoque más hacia la enfermedad; en el que la planificación de acciones sea más específica a puérperas con hemorragia. Asimismo, combinar lo estandarizado con la individualización, para lograr una mayor efectividad en la atención a esta complicación grave principal causa de la mortalidad materna en el mundo. Por ello el cuidado de enfermería deberá asumir acciones frente a la seguridad de la paciente, desde la promoción del trabajo en equipo, hasta fortalecimiento de competencias para la implementación guías de prácticas que garanticen un accionar más rápido y eficiente(AU)
Puerperal hemorrhage causes an increase in the number of admissions to intensive care units, which in turn requires greater and better care from nursing staff. This work aims to reflect on the main elements to take into account for nursing care of postpartum women with hemorrhage, in the context of the intensive care unit. The care plan for postpartum women with hemorrhage should be based on nursing diagnoses that focus more on the disease; in which action planning is more specific to postpartum women with hemorrhage. Likewise, combine standardization with individualization, to achieve greater effectiveness in the care of this serious complication, the main cause of maternal mortality in the world. Therefore, nursing care must take actions regarding patient safety, from promoting teamwork to strengthening skills for the implementation of practice guides that guarantee faster and more efficient action(AU)
Assuntos
Humanos , Período Pós-Parto , Segurança do Paciente , Hemorragia Pós-Parto/enfermagem , Complicações do Trabalho de Parto/diagnóstico , Cuidados de Enfermagem , Cuidados de Enfermagem/métodos , Diagnóstico de Enfermagem , Unidades de Terapia IntensivaRESUMO
Postpartum hemorrhage (PPH) is a leading contributor to maternal morbidity and mortality in the United States and globally. Although the rate of PPH is generally decreasing nationally, severity of PPH appears to be increasing, potentially related to the various comorbidities associated with women of childbearing age. There is increasing evidence of risks associated with allogeneic blood transfusion, which has historically been the classic therapeutic approach for treatment to PPH. Pregnant women are particularly susceptible to the implications of sensitization to red cell antigens, a common sequela to allogenic blood transfusion. Autologous blood transfusion eliminates the potential of communicable disease transmission as well as the conceivable threat of a blood transfusion reaction. Recent technological advances allow cell salvage coupled with the use of a leukocyte filter to be used as an alternative approach for improving the outcome for women experiencing a PPH. Modest changes in standard operating procedure and continued training in use and application of cell salvaged blood may assist in minimizing negative outcomes from PPH. Salvaged blood has been demonstrated to be at least equal and often superior to banked blood. We discuss nursing implications for application of this technology for women with PPH. Continued research is warranted to evaluate the impact that application of cell salvage with filtration has on the patient experiencing a PPH.
Assuntos
Transfusão de Sangue Autóloga/métodos , Hemorragia Pós-Parto/terapia , Competência Clínica/normas , Contraindicações , Educação Continuada em Enfermagem/métodos , Feminino , Humanos , Parto , Hemorragia Pós-Parto/economia , Hemorragia Pós-Parto/enfermagem , GravidezRESUMO
OBJETIVO: evaluar los cambios en la pérdida estimada de sangre y tasas de Hemorragia Posparto [HPP] derivados del entrenamiento en el Manejo Activo de la Tercera Etapa del Parto [MATED] en cinco Clínicas Materno Infantiles del departamento de Yoro, Honduras. METODOLOGÍA: durante nueve meses, el equipo de investigación enseña las habilidades sobre la pérdida estimada de sangre, establece una tasa base para la HPP y enseña el manejo activo de la tercera etapa del parto. En cada nacimiento se registran la pérdida estimada de sangre, los resultados para la madre y el neonato, así como el uso calculado de Oxitocina en el periodo posnatal. Los datos obtenidos se analizan estadísticamente con SPSS descriptivo, prueba-T y Chi-cuadrado. RESULTADOS: el periodo de estudio previo al entrenamiento en MATEP incluye 178 casos, el periodo posterior al entrenamiento incluye 392 casos. La pérdida estimada de sangre durante el periodo previo es de 109 ml en promedio, comparado con 81 ml en promedio que se obtiene durante el periodo posterior al entrenamiento (p=.004). En la fase previa y posterior a/ entrenamiento, el uso de Oxitocina en el periodo posparto es de 99.5%, aunque en el 17% de los casos reportados la administración de Oxitocina se realiza después de la expulsión de la placenta. Después del entrenamiento en MATER la tasa de hemorragia posparto disminuye del 7.3% al 3.8%, dato que no es estadísticamente significativo.
AIM: evaluate the changes in estimated blood loss and Post Partum Hemorrhage [PPH] rates with dissemination of Active Management of Third Stage of Labor [AMTSL] training to five Clinicas Materno Infantiles in the state of Yoro, Honduras. METHODS: over a nine month period, the research team utilized a two part training module to first teach the skills of estimated blood loss to establish a baseline rate for PPH and then in the second phase teach skills of active management of third stage labor. Estimated blood loss, outcomes for mother and neonate as well as the use and timing of Oxytocin in the postpartum period were recorded for each birth for the research team. The collected data were analyzed with SPSS for descriptive, t-test and chi-square statistics. RESULTS: pre-AMTSL training period N= 178, post AMTSL training N=392. Estimated blood loss pre-AMTSL training was a mean of 109 ml compared with post-training period of 81ml (p=.004). The use of Oxytocin in the postpartum period was 99.5% in both pre and post AMTSL training, though 17% of the cases reported Oxytocin administration after delivery of the placenta. The postpartum hemorrhage rate decreased from 7.3% to 3.8% after the AMTSL training, but was not statistically significant. CONCLUSION: AMTSL training reduced estimated blood loss though did not significantly change PPH rates in this study. Use of Oxytocin postpartum has become a regular component of care provided.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Ocitocina/administração & dosagem , Hemorragia Pós-Parto/enfermagem , Hemorragia Pós-Parto/tratamento farmacológico , Parto/sangue , Honduras , Complicações do Trabalho de Parto/sangueRESUMO
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Safe Motherhood policies have been directed towards the reduction of PPH by recommending active management of third-stage labor as the standard of care. One component of active management involves routine use of a uterotonic agent within 1 minute of the delivery of the baby. A case study at Clínica Materno-Infantil, a free-standing public birth center in Honduras, is presented, focusing on methods to reduce PPH. The nursing staff was trained to estimate blood loss and in methods to manage PPH, including elements of active management of the third stage of labor. Medical records were reviewed and an analysis of PPH management compared to estimated blood loss (EBL) was conducted. There was no significant correlation between PPH management techniques and EBL (r = .060; P = .368). There was a statistically significant (P < .001) correlation between oxytocin administration and lower EBL (r = -.232), indicating that there was less blood loss when oxytocin was administered. At Clínica Materno-Infantil, routine use of a uterotonic agent appears beneficial and further implementation of active management of the third stage of labor appears warranted.
Assuntos
Tocologia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/enfermagem , Adolescente , Adulto , Educação Continuada em Enfermagem , Feminino , Transição Epidemiológica , Honduras/epidemiologia , Humanos , Serviços de Saúde Materna/tendências , Tocologia/educação , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Serviços de Saúde Rural/tendênciasRESUMO
OBJECTIVE: To understand the process of decision making by auxiliary nurses regarding postpartum bleeding among women in the Dominican Republic. DESIGN: An ethnographic qualitative design of semistructured interviews and participant observation. PARTICIPANTS: Twenty four auxiliary nurses on a maternity unit of a referral hospital in the Dominican Republic. FINDINGS: Auxiliary nurses use specific criteria and logic to decide if postpartum maternal bleeding is excessive. However, systematic postpartum assessments are not routinely conducted on every woman. MAIN OUTCOME MEASURES: A decision tree that traces how auxiliary nurses evaluate postpartum bleeding indicates that they have knowledge of contemporary obstetric nursing care, but the organization of care delivery is not structured for them to apply it routinely. CONCLUSIONS: A collaboration of U.S. midwives and Dominican nurses will build on the assets of the auxiliary nurses. Rather than focusing the content of educational conferences on current knowledge of labor and delivery, an important next step is modeling woman- and family-centered care. The U.S. midwives and Dominican nurses are committed to finding empowering and effective ways to improve maternity care.