Relevance to clinical practice
Nursing practice raises many questions related to the
effectiveness of interventions, the accuracy of evaluation
procedures, the strength of causal relationships, the
cost-effectiveness of nursing interventions, as well as the
significance of the situation, experiences, beliefs and attitudes
of users (Dicenso et al. 1998). As such, it can be
assumed that health care based on evidence is the one that
incorporates the best available evidence on clinical decisions
made by midwives. For the practice emerges the suggestion
of the need to determine, in each context, the gaps in the
practice of nurse specialist in obstetrics and maternal health
for the active management of TSL to update the knowledge
and practices with more recent scientific evidence. With
regard to proposals for future research, the results support
the realisation of large randomised controlled trials to:
• Determine the effectiveness of the joint application of
the five interventions of active management of TSL, in
reducing blood loss and the risk of PPH in women with
vaginal delivery.
• Determine the timing and manner of administration of
oxytocin in TSL.
• Evaluate whether uterine massage in TSL promotes the
expulsion of the placenta without increasing maternal
complications.
• Objectively determine blood loss and clinical repercussions
in the postpartum period.
As PPH is a major cause of maternal death and morbidity
worldwide, the relevance of developing and implementing
nursing intervention programmes cannot be
stressed enough. These programmes use a predefined set
of practices for the active management of TSL to prevent
PPH.