Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i12.1164Keywords:
Postpartum haemorrhage, PPH, E-MOTIVEAbstract
Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service.
References
National Department of Health, South Africa. Saving Mothers; 2017 - 2019. The eighth report of the National Committee for Confidential Enquiry into Maternal Deaths in South Africa. Pretoria: NDoH, 2020.
Fawcus S. Maternal deaths from obstetric haemorrhage 2017 - 2019; are we overlooking deaths from postpartum haemorrhage after vaginal delivery? Obstetr Gynaecol For 2020;30(4):8-11.
Gallos I, Devall A, Martin J, et al. Randomised trial of early detection and treatment of postpartum hemorrhage. N Engl J Med 2023:389;11-21. https://doi.org/10.1056/nejmoa2303966
Dr Tedros. Good news: a new trial to manage postpartum bleeding shows highly promising results. This could represent a major breakthrough in reducing maternal deaths. #HealthForAll. https:// twitter.com/DrTedros/status/1655920280869412864?t=_6Odf8AjaAcYKrc7QFxyKQ&s=08 (accessed 10 November 2023).
WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): An international, randomised, double-blind, placebo-controlled trial. Lancet 2017;389(10084):2105-2116. https://doi.org/10.1016%2FS0140-6736(17)30638-4
Althabe F, Therrien MNS, Pingray V, et al. Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation. Int J Gynaecol Obstet 2020;148(3):290-299. https://doi. org/10.1002/ijgo.13028
Singata-Madliki M, Hofmeyr GJ. A novel, re-usable ‘Safe birth Tray’ for postpartum blood loss monitoring: A preliminary acceptability assessment. Int J Gynecol Obstetr 2021;155(3):553-555. https://doi.org/10.1002/ijgo.13817
Esau J, De Waard L, Els C. The utility and acceptability of a Brass V Drape versus a blood loss monitoring device for the collection of postpartum blood loss in low-risk term vaginal deliveries; a prospective parallel randomised trial. 41st Conference on Priorities in Perinatal Care in Southern Africa 7 - 10 March 2023, Indaba Conference Centre, Gauteng, South Africa. Abstract, page 23.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 M Singata-Madliki, S Fawcus, N Moran, Edna Arends, E Muller, S Mandondo, G J Hofmeyr
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ 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.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
