Cluster RCT | Early detection and treatment bundle reduces postpartum hemorrhage complications

Summary: An international, cluster-randomized trial assessed the effectiveness of a multicomponent clinical intervention for postpartum hemorrhage in patients having vaginal delivery. The study involved 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, with 210,132 patients. The intervention group utilized a calibrated blood-collection drape for early detection of postpartum hemorrhage and a first-response treatment bundle, while the control group received usual care.

The primary outcome measured was a composite of severe postpartum hemorrhage (blood loss ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. The results showed a significant reduction in primary-outcome events in the intervention group (1.6%) compared to the usual-care group (4.3%) with a risk ratio of 0.40 (95% CI, 0.32 to 0.50; P<0.001). Postpartum hemorrhage detection rates were 93.1% and 51.1% in the intervention and usual-care groups, respectively, and treatment bundle adherence was 91.2% and 19.4%, respectively.

These findings demonstrate that early detection of postpartum hemorrhage and the use of a bundled treatment approach can significantly reduce the risk of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding among patients having vaginal delivery. The results have important implications for improving clinical practice and reducing postpartum hemorrhage complications globally.

Article: Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Lifesaving solution dramatically reduces severe bleeding after childbirth – World Health Organization

Commentary on Twitter

In a large, cluster-randomized trial involving patients with PPH after vaginal delivery, a multicomponent intervention lowered the risk of severe PPH, laparotomy for bleeding, or maternal death from bleeding. Full results of the E-MOTIVE trial: https://t.co/NjcE4Q1rxM#IMNHC2023

— NEJM (@NEJM) May 9, 2023