When Is Postpartum Haemorrhage Treatment Initiated? A Nested Observational Study Within the E-MOTIVE Trial.

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Global Health

Background:

• Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality worldwide.
• Effective and timely management of PPH is crucial for improving maternal outcomes.
• The MOTIVE (Massage, Oxytocic drugs, Tranexamic acid, IntraVenous fluids, Examination) bundle is a proposed intervention to standardize PPH care.

Purpose of the Study:

• To compare the frequency and timing of PPH treatment initiation between hospitals using the MOTIVE bundle and those providing usual care.
• To assess the impact of the MOTIVE bundle on the comprehensive and timely management of PPH.

Main Methods:

• A nested prospective observational study was conducted in hospitals across Nigeria, Kenya, Tanzania, and South Africa.
• Healthcare workers treating PPH were observed for 1-2 weeks between June and December 2022.
• Data were collected on the initiation of individual treatments and the complete MOTIVE bundle in E-MOTIVE and usual care settings.

Main Results:

• Hospitals implementing the MOTIVE bundle showed a higher treatment rate for PPH (11% vs. 8%).
• Nearly all PPH cases (97%) in E-MOTIVE hospitals received the complete MOTIVE bundle, compared to 36% in usual care hospitals.
• Initiation of all MOTIVE bundle components was faster in E-MOTIVE hospitals (median 13 minutes vs. 18 minutes), with 79% completed within 20 minutes compared to 22% in usual care.

Conclusions:

• The MOTIVE bundle facilitates timely and comprehensive PPH management.
• Emphasis on timely initiation of all MOTIVE bundle components within 15-20 minutes is key for effective PPH treatment.
• Scaling up the E-MOTIVE care model holds significant potential for improving maternal health outcomes in low-and-middle-income countries.