Major breakthrough in reducing PPH risk.

Postpartum hemorrhage (PPH) is the leading cause of maternal death, accounting for 27% of maternal deaths worldwide. Delays in the detection or initiating treatment of postpartum hemorrhage can result in complications or death.

Despite strong efforts to adopt and scale up use of evidence-based interventions to prevent, detect, and treat PPH, three critical challenges remain. First, PPH is often undetected or detected late, leading to treatment delays. Second, when PPH does occur, there is often delayed or inconsistent use of life-saving interventions. Third, there is poor uptake of existing prevention and treatment guidelines at the point-of-care.

The E-MOTIVE project, led by the University of Birmingham and the World Health Organization and in collaboration with the Nossal’s Gender and Women’s Health team, aimed to address these three challenges through a multi-component strategy to: 1) improve early detection of PPH by using a calibrated blood loss collection drape, and 2) implement a first response treatment bundle to be delivered in quick succession and consisting of uterine massage, oxytocic drugs, tranexamic acid, and a process for examination and escalation if bleeding continued. Delivery of the E-MOTIVE intervention was supported by implementation strategies including the use of PPH trolleys or carry cases, on-site simulation-based training, audit and feedback of actionable data, and local champions (midwives and doctors).

The E-MOTIVE trial to test this new care bundle to treat postpartum hemorrhage (PPH) – blood loss of ≥500mL after birth –  was just published in NEJM and launched at the International Maternal and Newborn Health Conference in Cape Town. The trial showed a remarkable 60% reduction in a composite outcome of severe PPH, death or laparotomy from bleeding. Nossal Institute researchers Associate Professor Meghan Bohren and Dr Shahinoor Akter (Gender and Women’s Health Unit) led the formative research to refine the intervention and implementation strategies, and the process evaluation of the trial. The trial results have been covered widely by WHO and work is already underway to update the WHO guidelines on postpartum hemorrhage.

The E-MOTIVE project was supported by a grant from the Bill & Melinda Gates Foundation.

Associate Professor Meghan Bohren heads the Gender and Women’s Health Unit at the Nossal Institute for Global Health. She currently leads research projects working to improve women’s experiences with pregnancy and childbirth care in low- and middle-income countries.