Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa

Authors

  • M Singata-Madliki Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South Africa
  • S Fawcus Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa
  • N Moran KwaZulu-Natal Department of Health; Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
  • Edna Arends Retired: Western Cape Department of Health, South Africa
  • E Muller Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South Africa
  • S Mandondo Eastern Cape Department of Health, East London, South Africa
  • G J Hofmeyr Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South Africa; Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana

DOI:

https://doi.org/10.7196/SAMJ.2023.v113i12.1164

Keywords:

Postpartum haemorrhage, PPH, E-MOTIVE

Abstract

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

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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).

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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

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Published

2023-12-04

Issue

Section

In Practice

How to Cite

1.
Singata-Madliki M, Fawcus S, Moran N, Arends E, Muller E, Mandondo S, et al. Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa. S Afr Med J [Internet]. 2023 Dec. 4 [cited 2024 Oct. 5];113(12):24. Available from: https://samajournals.co.za/index.php/samj/article/view/1164

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