Published in the New England Journal of Medicine this month, E-MOTIVE – a set of interventions to manage postpartum haemorrhage (PPH), has been found to reduce heavy bleeding by 60%.
This is a major breakthrough in reducing deaths from childbirth-related bleeding and Ammalife are delighted to have been a partner; providing vital funds to purchase Tranexamic Acid and Neoprene antishock garments to the trial site’s in Tanzania, Kenya and Nigeria to enable the research, and to support the reduction of PPH related deaths in these locations.
Postpartum haemorrhage (PPH) – defined as the loss of more than 500 mL of blood within 24 hours after birth – is the leading cause of maternal mortality worldwide. It affects an estimated 14 million women each year and results in around 70 000 deaths – mostly in low and middle-income countries – equivalent to 1 death every 6 minutes
“Postpartum haemorrhage is scary, not always predictable, but absolutely treatable. Nonetheless, its impacts around the world are tragic,” said Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO and head of the United Nations’ Special Programme of Research, Development and Research Training in Human Reproduction (HRP). “No woman should fear for her life when giving birth. Effective solutions to tackle postpartum bleeding need to be available and accessible so that all women can experience a safe birth and a healthy future with their families.”
The study, which involved over 200 000 women in four countries, found that objectively measuring blood loss using a simple, low-cost collection device called a ‘drape’ and bundling together WHO recommended treatments – rather than offering them sequentially – resulted in dramatic improvements in outcomes for women. Severe bleeding – when a woman loses more than a litre of blood after birth – was reduced by 60%, and they were less likely to die.
There was also a substantial reduction in the rate of blood transfusions for bleeding, which is of particular importance in low-income countries where blood is a scarce and expensive resource.
“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,” said Ammalife Founder, 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. “Time is of the essence when responding to postpartum bleeding, so interventions that eliminate delays in diagnosis or treatment should be gamechangers for maternal health.”
Currently, a major challenge in responding to PPH is that it is often detected too late to respond effectively. Most providers use visual inspection to assess bleeding, which tends to underestimate blood loss and can lead to life-threatening delays in treatment. When treatment is provided, this is typically done in a sequential manner with gaps between each intervention – costing more time if the first options are not effective.
The recommended E-MOTIVE package includes early and accurate detection of PPH using a blood collection drape. This is complemented by an immediate treatment bundle where indicated, including uterine massage, medicines to contract the womb and stop the bleeding, intravenous fluid administration, an examination and, when needed, escalation to advanced care. In the trial, the E MOTIVE intervention was supported with an implementation strategy consisting of specific training, PPH trolleys or carry cases, engagement of local champions, audits and feedback. All components of the E MOTIVE intervention can be performed by midwives.
“Finding evidence based, effective and practical solutions to saving mothers lives was a founding principle of Ammalife, and E-MOTIVE is the epitome of that.” says Imran Pasha, Ammalife Chair of Trustee’s, “We will continue to work closely with our partners at the University of Birmingham and the research locations to ensure we bring this landmark research to practice.”