Researchers’ success in identifying and treating bleeding in patients shows E-MOTIVE could be rolled out across South Asia and beyond.
A new study by Birmingham researchers published in The Lancet Obstetrics, Gynaecology and Women’s Health has found that the previously studied E-MOTIVE intervention to identify and treat postpartum haemorrhage in African settings is also highly effective in south Asia, saving lives.
Postpartum haemorrhage (PPH) is defined as blood loss of 500 mL or more after birth. It is a major cause of maternal mortality and morbidity, with an estimated 27 million women experiencing PPH worldwide every year, resulting in more than 43,000 maternal deaths.
The previous Birmingham-led landmark E-MOTIVE trial conducted in Africa found that identifying PPH by reading off blood loss accurately in a simple, plastic pouch, and further treating PPH with a bundle of simple interventions greatly improved outcomes for mothers giving birth.
Funded by the Gates Foundation, the aim of this study was to evaluate the effectiveness and implementation of the E-MOTIVE intervention in a south Asian setting, in Pakistan. No previous studies have assessed the implementation or effectiveness of the E-MOTIVE intervention outside of Africa.
The E-MOTIVE treatment package involves early detection of PPH using a simple, transparent, calibrated blood-collection drape that measures blood loss accurately allowing early diagnosis (E) of PPH by the attending healthcare worker, and a treatment bundle (MOTIVE) that includes uterine massage, oxytocic drugs (to help the uterus contract), tranexamic acid (to reduce bleeding), intravenous fluids and examination and escalation of care, if required.
By enabling healthcare workers to recognise and treat postpartum haemorrhage quickly and accurately, we can prevent avoidable deaths and improve outcomes for mothers globally.
Researchers carried out the study on the E-MOTIVE treatment package’s effectiveness in 8 hospitals across the Punjab and Sindh provinces, working collaboratively with researchers from Aga Khan University, Pakistan. They compared the usual care for PPH, where PPH was detected by crude visual estimation of blood loss, with the E-MOTIVE intervention. Over 14,000 women were included in the study, with over 9,000 receiving usual care and over 5,000 receiving E-MOTIVE.
The study found that severe PPH (more than 1000 mL of blood loss) occurred in 183 women (2%) in the usual care group, compared to only 2 women (less than 0.1%) in the E-MOTIVE group. They also found that detection of PPH improved from 51% in usual care to 100% while using the calibrated blood collection drape in the E-MOTIVE group. Additionally, no maternal deaths occurred in the E-MOTIVE group, compared to 3 deaths in the usual care group.
Dr Adam Devall, Professor of Maternal Health Clinical Trials at the University of Birmingham and lead author for this study, said: “These findings demonstrate that the E-MOTIVE approach can be successfully implemented in different health system settings. By enabling healthcare workers to recognise and treat postpartum haemorrhage quickly and accurately, we can prevent avoidable deaths and improve outcomes for mothers globally”.
The E-MOTIVE treatment package enabled accurate and early detection of PPH, allowing for faster and more effective management in a simple and cost-effective manner. These findings are particularly important given the remarkable success of E-MOTIVE in Pakistan, demonstrating that the approach can be effectively implemented beyond the African settings in which it was first evaluated. The study therefore provides strong support for the wider adoption of E-MOTIVE across hospitals and maternity care settings in South Asia and potentially in other regions globally.
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Professor of Maternal Health Clinical Trials
Staff profile for Dr Adam Devall, Professor of Maternal Health Clinical Trials in the Department of Metabolism and Systems Science, University of Birmingham.
