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African study finds solution to reduce for childbirth-related haemorrhaging

A novel approach – known as E-motive – may help reduce mortality caused by childbirth-related bleeding, according to results of a study carried out in South Africa, Nigeria, Tanzania and Kenya, and released this week by World Health Organisation (WHO) and University of Birmingham researchers.

Childbirth-related bleeding, also known as postpartum haemorrhage (PPH), is thought to be responsible for 30% to 50% of infant deaths in Africa, reports News24.

The rate on the continent this year stands at 41.586 deaths per 1 000 live births, a 2.75% decline from 2022.

PHH is blood loss of more than 500ml within 24 hours after delivery and annually, affects about 14m women, and causes one death every six minutes, or about 70 000 fatalities, predominantly in low- and middle-income nations.

The findings of the first trial phase of E-motive involving 200 women were that the risk of severe bleeding was lowered by 60%, with a much lower mortality rate.

The E-motive process objectively measures blood loss using a simple, low-cost collection device called a “drape” and bundling together WHO recommended treatments, rather than offering them sequentially.

Professor Arri Coomarasamy, who led the trial and is the co-director of the WHO collaborating centre on global women’s health at the University of Birmingham, said the results were impressive.

“This new approach to treating postpartum haemorrhage could radically improve women’s chances of surviving childbirth globally, helping them get the treatment they need when they need it.”

The study was published in the New England Journal of Medicine.

Study details

Randomised trial of early detection and treatment of postpartum haemorrhage

Ioannis Gallos, Adam Devall, James Martin, Lee Middleton, Leanne Beeson, Hadiza Galadanci, Fadhlun Alwy Al-beity, Zahida Qureshi, Justus Hofmeyr, Neil Moran, Sue Fawcus, Lumaan Sheikh, et al.

Published in the New England Journal of Medicine on 9 May 2023

Abstract

Background
Delays in the detection or treatment of postpartum haemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum haemorrhage, and delayed or inconsistent use of effective interventions may be able to be addressed by a treatment bundle.

Methods
We conducted an international, cluster-randomised trial to assess a multicomponent clinical intervention for postpartum haemorrhage in patients having vaginal delivery. The intervention included a calibrated blood-collection drape for early detection of postpartum haemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe postpartum haemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. Key secondary implementation outcomes were the detection of postpartum haemorrhage and adherence to the treatment bundle.

Results
A total of 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32 to 0.50; P<0.001). Postpartum haemorrhage was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41 to 1.76), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI, 3.88 to 6.28).

Conclusions
Early detection of postpartum haemorrhage and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe postpartum haemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery.

 

NEJM article – Randomised trial of early detection and treatment of postpartum haemorrhage (Open access)

 

News24 article – Study in Africa a game changer for childbirth-related bleeding (Open access)

 

See more from MedicalBrief archives:

 

Cochrane Review identifies alternative drugs better to prevent PPH

 

Tranexamic acid decreasing death risk from post-partum blood loss

 

Cooling cuts post partum blood loss

 

 

 

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