Discussion
This section describes the synthesis and interpretation of
the results, in which data shown in the analyses of the theoretical
articles (Table 1) were compared to answer the
research question (Souza et al. 2010). The analyses of the
articles that met the inclusion criteria in this integrative literature
review allowed for the realisation that intervention
strategies in the active management of TSL differ in regard
to the specific elements of which they are comprised. The
extraction of relevant concepts covered in each article was
made, compared and grouped by similarity of content in
the form of empirical categories and constructed into the
five categories outlined in Fig. 1.
The administration of oxytocin one minute after birth of
the newborn is the main intervention to reduce PPH and
the first uterotonic option, because it acts quickly and effectively
with minimal adverse effects, and can be used in all
women (WHO 2007, FIGO-SMNH Committee 2012). If
oxytocin is not available, other uterotonics can be used,
such as ergometrine, methylergometrine and misoprostol.
However, considering that these drugs cause adverse effects
and are not suitable for women with hypertension or heart
disease, they are not usually used in Portugal in the prevention
of PPH.
The results of an exploratory study involving twelve
European countries showed interesting differences in uterotonic
management practices. In Portuguese hospitals, oxytocin
is the drug of choice for prophylaxis of PPH and is the
first choice in 95% of the country’s institutions. Its administration
is performed after placental expulsion in 69–77%
of hospitals in Italy, Portugal and Spain (Winter et al.
2007).
The aforementioned facts are the main reason that oxytocin
was studied in the drug component of the active management
of uterotonic administration in this integrative
review. Taking into account the three Cochrane reviews
included in this study, oxytocin is the drug of choice in the
TSL for preventing PPH (McDonald et al. 2009, Cotter
et al. 2010, Soltani et al. 2010).
According to Kahn et al. (2008), administration of oxytocin
in the TSL reduces the risk of PPH by 40% and can
be administered at birth or immediately after placental
discharge. Considering this fact, and in response to the initial
questions outlined in this review, it can be concluded