Rapid response, E-MOTIVE and suction tamponade for postpartum haemorrhage (ARREST PPH): A quality improvement project
Article Sidebar
Main Article Content
Abstract
Background. Research supports routine monitoring of blood loss, early bundled treatment of postpartum haemorrhage (PPH), and suction uterine tamponade for refractory PPH.
Objectives. To implement recent research evidence and World Health Organization guidance on the prevention and management of PPH.
Methods. We co-designed, with input from midwifery and medical staff, and conducted a quality-of-care improvement project at Princess Marina Hospital, Gaborone, Botswana. We conducted training and placed posters in the labour ward promoting evidence- based third-stage care with a novel checklist mnemonic, BOND (Baby skin-to-skin, Oxytocic, iNitiate blood loss monitoring, Delay cord clamping); use of the reusable MaternaWell Tray for blood loss monitoring after birth; early implementation of the MOTIVE bundle for PPH (uterine Massage, Oxytocin, Tranexamic acid, IntraVenous fluids, Examination, and, if needed, Escalation); and early use of suction tube uterine tamponade with the improvised Levin tube for refractory PPH. We provided in-service mentorship.
Observations. Unstructured observations indicate good uptake of the treatment interventions. Routine blood loss monitoring has been difficult to institutionalise.
Conclusion. The mnemonic-driven checklist approach is promising. Creative solutions are needed to further advance behaviour change. Training materials are available on the Obstetric Skills Library (YouTube).
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
1. Nkhwalume L, Mashalla Y. Maternal mortality trends at the Princess Marina and Nyangabwe referral hospitals in Botswana. Afr Health Sci 2019;19(2):1833- 1840. https://doi.org/10.4314/ahs.v19i2.5
2. GallosID,YunasI,DevallAJ,etal.Uterotonicagentsforpreventingpostpartum haemorrhage: A network meta-analysis. Cochrane Database Syst Rev 2025, Issue 4. Art. No.: CD011689. https://doi.org/10.1002/14651858.CD011689. pub4
3. Gallos I, Devall A, Martin J, et al. Randomised trial of early detection and treatment of postpartum hemorrhage. N Engl J Med 2023;389(1):11-21. https://doi.org/10.1056/NEJMoa2303966
4. Phillips JM, Eppes C, Rodriguez M, Sakamoto S. Traditional uterine tamponade and vacuum-induced uterine tamponade devices in obstetrical hemorrhage management. Am J Obstet Gynecol MFM 2023;5(2S):100739. https://doi. org/10.1016/j.ajogmf.2022.100739
5. Hofmeyr GJ, Middleton K, Singata-Madliki M. Randomized feasibility study of suction-tube uterine tamponade for postpartum hemorrhage. Int J Gynaecol Obstet 2019;146(3):339-343. https://doi.org/10.1002/ijgo.12889
6. Hofmeyr GJ, Singata-Madliki M. Novel suction tube uterine tamponade for treating intractable postpartum haemorrhage: Description of technique and report of three cases. BJOG 2020;127(10):1280-1283. https://doi. org/10.1111/1471-0528.16169
7. Govender L, Naidoo P, Hofmeyr GJ. Preference for uterine tamponade devices as a barrier to research: A provider survey. Am J Obstet Gynecol MFM 2023;5(7):100970. https://doi.org/10.1016/j.ajogmf.2023.100970
8. Shajahan A, Paily V, Sudhamma A, et al. Postpartum haemorrhage management: A randomised controlled trial comparing transvaginal uterine artery clamp, vacuum-assisted uterine contraction and condom tamponade. Eur J Obstet Gynecol Reprod Biol 2024;300:337-344. https://doi.org/10.1016/j. ejogrb.2024.07.027
9. Singata-Madliki M, Nieto-Calvache AJ, Rivera Torres LF, et al. Suction tube uterine tamponade versus uterine balloon tamponade for treatment of refractory postpartum hemorrhage: A randomised clinical feasibility trial. Int J Gynaecol Obstet 2025;170(1):326-337. https://doi.org/10.1002/ijgo.16164
10. National Department of Health, South Africa. National Integrated Maternal and Perinatal Care Guidelines for South Africa. 5th ed. 2024. https:// knowledgehub.health.gov.za/elibrary/national-integrated-maternal-and- perinatal-care-guidelines-south-africa (accessed 3 January 2026).
11. Begum F, Nieto-Calvache AJ, Schlembach D; FIGO Committee on Childbirth and PPH. FIGO recommendations on objective measurement of blood loss after birth for early detection of postpartum hemorrhage. Int J Gynaecol Obstet 2025;171(3):933-950. https://doi.org/10.1002/ijgo.70523
12. Hofmeyr GJ, Ryan RJ, Mussa A, et al. Improving postpregnancy contraceptive method choice and long-acting reversible contraception provision in Botswana: A quality improvement pilot. BMJ Sex Reprod Health 2023;49(4):293-297. https://doi.org/10.1136/bmjsrh-2022-201748
13. Nassali MN, Russell JC, Tsuaneng M, et al. Promoting respectful maternity care with the WHO labor care guide and the checklist mnemonic ‘COPE’: A quality improvement project. Int J Gynaecol Obstet 2025;171(2):798-804. https://doi. org/10.1002/ijgo.70238