Hemorragia pós-parto : determinantes e conhecimentos dos profissionais na assistência ao parto
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Data
2025-02-25
Autores
Santos, Alendiana da Silva
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Universidade Federal do Espírito Santo
Resumo
This dissertation aims to analyze the magnitude of postpartum hemorrhage (PPH) in Brazil from different perspectives. To achieve this, two studies with distinct methodologies were conducted. The first sought to develop a theoretical-conceptual model of PPH and describe the characteristics of women affected by this condition in the “Born in Brazil” survey, a descriptive analysis based on 47 identified cases of PPH. The results indicate that the majority of women affected by PPH self-identified as non white (72,3% or 34) and were aged between 20 and 34 years (61,7% or 29). In educational terms, 76,6% (36) had not completed high school, and 59,6% (28) reported having received lasting emotional support. Among clinical conditions, 6,4% (3) presented anemia, and 27,6% (13) were overweight. Regarding obstetric factors, 8,5% (4) of the women had hypertensive complications, and despite all births being normal, in accordance with World Health Organization (WHO) recommendations, 51,1% (24) of the women experienced some genital trauma during delivery. Additionally, 19,1% (9) of the newborns presented macrosomia, a factor that may increase maternal and neonatal risks. The study's conclusion suggests that socioeconomic vulnerability, limited access to obstetric care, and unfavorable clinical conditions elevate the risk of PPH, and the occurrence of genital traumas underscores the need to review obstetric practices. The second study aimed to evaluate the profile and practices of health professionals regarding the management of PPH in maternity hospitals in Espírito Santo (ES) according to their professional experience. A cross-sectional study was conducted with 254 professionals (doctors, nurses, and nursing technicians), using a questionnaire that addressed critical practices such as administration of uterotonics, pulse checking, and assessment of atonic uterus. The results show that a significant percentage of professionals do not perform these essential practices, which may negatively impact the management of PPH. Only 44,9% (114) of the professionals conducted examinations to identify the cause of PPH, only 9,1% (23) administered uterotonics, and 16,1% (41) checked the pulse. Although uterine massage did not show significant differences between the groups, only 28,7% (73) performed the intervention, and only 9,4% (24) reported having performed bimanual uterine compression. Finally, only 30,7% (78) evaluated uterine atony. The performance of essential practices was more frequent among professionals with greater experience, suggesting that training and practice time influence the effectiveness of interventions. These findings highlight the importance of continuing education programs that integrate theoretical and practical education for all healthcare professionals, regardless of experience level, to ensure the consistent implementation of critical practices, improving maternal safety and the quality of care in obstetric emergency situations. Further studies are needed to inform public policies aimed at maternal health, deepening the understanding of the predisposing factors of PPH, investigating barriers to implementing critical practices, and assessing the effectiveness of educational interventions in various work contexts
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Hemorragia pós-parto , Saúde materna , Complicações obstétricas