Global trial provides new tools for detecting post-birth haemorrhage
The results of a global study provide healthcare workers in low resource settings new tools to detect and diagnose potentially deadly postpartum haemorrhage, a new study from the University of Melbourne suggests.
Postpartum haemorrhage is a condition that accounts for nearly one quarter of maternal deaths worldwide, with the vast majority occurring in low and middle-income countries.
Without rapid detection and appropriate management, it can be fatal.
Professor Meghan A. Bohren from the Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, led a multinational research team to evaluate the feasibility and acceptability of the E-MOTIVE trial – a multi-country trial that showed a 60% reduction in complications from postpartum haemorrhage.
The study was published in The Lancet Global Health.
The E-MOTIVE intervention consisted of three key components.
The first was a calibrated obstetric drape, a simple plastic sheet with a funnel marked with measurement lines, designed to be placed under women giving birth vaginally to collect blood and help detect excessive blood loss early.
The second was a treatment bundle, including uterine massage, oxytocic drugs, intravenous fluids, examination of the genital tract and escalation if needed, designed to manage postpartum haemorrhage quickly and effectively.
This intervention approach was supported by simulation training, audit and feedback, a trolley to store supplies to manage PPH, and dedicated implementation champions who drove change across the 78 study hospitals.
Working in collaboration with midwives and doctors in Kenya, Nigeria, South Africa, and Tanzania, this process evaluation identified specific considerations to inform E-MOTIVE’s scalability, sustainability, and roll-out.
The study used a mixed-methods approach, combining direct observation of women giving birth vaginally, with qualitative interviews and quantitative surveys with health workers.
Professor Bohren said the results were remarkably positive.
“The study showed that both the obstetric drape and the MOTIVE treatment bundle were being used in practice, were feasible to implement in the study hospitals, and were viewed favourably by health workers,” she said.
"The E-MOTIVE strategy equips frontline maternal health workers with vital tools to promptly recognise and treat postpartum haemorrhage. The potential impact on preventing avoidable maternal deaths from PPH is clear. But now is the time for policymakers and health leaders to prioritise maternal health and bring these best practices to scale, especially in low-resource settings where needs are greatest.”
97% of health workers agreed that the drape improved detection of postpartum haemorrhage and that they liked using it.
Polycarp Oyoo, a midwife from Kenya involved in the E-MOTIVE trial said: “The drape supported health workers to objectively estimate blood loss and reduced workload by making the delivery process clean, with no blood and other stains to clean later.”
99% of health workers agreed that the treatment bundle made postpartum haemorrhage management more effective and 98% liked using it.
Adeosun Love Funmi, a Nigerian midwife involved in the trial implementation, said: Using the bundle has opened medical professionals to a better way to save lives during postpartum haemorrhage. The bundle, once triggered, is effective in treating postpartum haemorrhage early and reducing operative procedures and maternal death.”
Professor Bohren said the study is also an important example of the value of conducting a mixed-methods process evaluation alongside trial implementation.
“By combining direct observations of women with vaginal birth, quantitative surveys and qualitative interviews with health workers, it gave a clear picture of how the trial worked in practice and the experiences of those implementing it,” she said.
“This approach provided a detailed account of health workers’ motivations, skills, and work environments as they changed their care practices. Such information is crucial for scaling up the trial results to real world settings, and improving health systems on a larger scale.”
Professor Meghan Bohren is Unit Head of the Gender and Women’s Health Unit at the Nossal Institute for Global Health. She leads domestic and international research projects to better integrate the voices of women, families, and healthcare workers into the design, measurement, and implementation of public health and clinical interventions.