In a study of postpartum hemorrhage conducted in Africa, early detection of postpartum hemorrhage and use of bundled treatment led to a lower risk of the primary outcome, researchers report, compared with usual care of vaginal delivery. The primary outcome comprised severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding
The international, cluster-randomized trial assessed a multicomponent clinical intervention (calibrated blood-collection drape for early detection of postpartum hemorrhage and a bundle of first-response treatments [uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation) for postpartum hemorrhage in patients having vaginal delivery. The intervention included a calibrated blood-collection drape for early detection of postpartum hemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation]), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care.
Based on a primary outcome of a composite of severe postpartum hemorrhage (blood loss, ≥1000 mL), laparotomy for bleeding, or maternal death from bleeding, the study showed: “A total of 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32 to 0.50; P<0.001). Postpartum hemorrhage was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41 to 1.76), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI, 3.88 to 6.28).”
Editorial: “In summary, the E-MOTIVE trial showed that the early detection and a bundled treatment for postpartum hemorrhage with the use of readily available and recommended medicines and intervention strategies substantially reduced the risk of severe outcomes from postpartum hemorrhage,” editorialists write. “The next challenge will be to achieve widespread adoption and implementation at scale in resource-limited environments.”