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Lifesaving solution dramatically reduces severe bleeding after childbirth

A trial of a set of interventions to manage postpartum haemorrhage, published in the New England Journal of Medicine, found a 60% reduction in heavy bleeding.

9 May 2023

Explaining the findings of the E-MOTIVE trial and the hopes for uptake around the world

Transcript

Professor Hadiza Shehu Galadanci (Africa Centre of Excellence for Population Health & Policy, Bayero University, Kano, Nigeria)

One of the most dangerous experiences of a woman after delivery is to bleed excessively and, as an obstetrician with 25 years experience, I think one of the conditions I dread most
is to have women that bleed after delivery.

There are interventions that have been proven to actually prevent women from bleeding after delivery and also to treat women when they bleed after delivery.

But unfortunately, we still have about 14 million people still having postpartum haemorrhage, which is excessive bleeding after delivery, as well as having up to 70,000 of them actually dying yearly because of postpartum haemorrhage.

And therefore, there is need for us to really find answers, through research.

What is it that we’re doing that is not right?

Professor Sue Fawcus (University of Cape Town, South Africa)

The majority of my working life since 1980, so nearly 40 years, has been in Southern Africa
and as an obstetrician in busy public sector maternity hospitals, I've had lots of opportunities to confront women with postpartum haemorrhage.

I sit on the South Africa Committee for Confidential Inquiry into Maternal Deaths.

My role is to look at all the women who've died from haemorrhage and nearly 90% of all those maternal deaths were clearly preventable.

The importance of doing the E-MOTIVE research is that it gave us concrete evidence that this very simple package of interventions, early detection with a drape and the immediate performance of five actions makes a huge difference to reducing severe blood loss.

And now we've shown it through rigorous research, we've got the authority to scale it up to every single hospital, in the country, in the world, to all health workers.

And if we can do that, it will really make a difference to reducing maternal deaths from PPH.

A new solution, known as E-MOTIVE, could provide a major breakthrough in reducing deaths from childbirth-related bleeding, according to a landmark study published today by researchers from the World Health Organization (WHO) and the University of Birmingham.

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 24 million women each year and results in around 70 000 deaths – mostly in low and middle-income countries - equivalent to 1 death every 7 minutes.

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) said:

“Postpartum haemorrhage is scary, not always predictable, but absolutely treatable. Nonetheless, its impacts around the world are tragic.

“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.

Professor Arri Coomarasamy

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:

“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.

“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.”

Excessive bleeding during childbirth poses a serious risk to mothers so a change in approach is needed

Transcript

Titles on-screen

  • Postpartum haemorrhage causes over 74,000 deaths per year.
  • It takes a life every seven minutes somewhere in the world.
  • 99% of these deaths are in low-resource countries.

Professor Arri Coomarasamy

The main reason that women die during childbirth is from postpartum haemorrhage.

So this is when the mother gives birth and you have a happy mother and happy child.

Everything seems normal. And then she starts to lose a little bit of blood, you know, and that's not uncommon. Many women lose small amounts of blood after childbirth, but then the bleeding continues and it can become more heavy and rapid.

And all of a sudden you see the colour draining from her face.

And within a few minutes, if you don't do the right things at that point in time, the right interventions, then within a few minutes you will start to see that she becomes shocked and unconscious.

And before long, she will collapse and she could die.

So it is a very rapid sequence of events from a happy mother to someone who has died.

So intervening at the right time with the right interventions is absolutely critical to save the life of these women.

Titles on-screen

Research led by the University of Birmingham and the World Health Organisation shows severe bleeding and deaths can be reduced by 60% if we diagnose postpartum haemorrhage early and treat with a bundle of interventions.

Read the article in the New England Journal of Medicine: nejm.org/doi/full/10.1056/NEJMoa2303966

Excerpts from the film "MORE THAN BLOOD"

Director/Producer - Rani Khanna

Music - Vasilis Alevizos and Anibal Vidal Astroza

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.

This research responds to one of the top research priorities identified by more than 130 experts from over 50 countries at the first Global Summit on PPH convened by WHO and HRP in March this year. The Summit marked the start of a collaborative global initiative aiming to substantially reduce the burden of PPH and its consequences in low- and middle-income countries.

The main results of this study are published today in the New England Journal of Medicine.

The parallel-cluster randomized trial was a partnership between the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham, United Kingdom, and WHO, with the study conducted in 80 hospitals across Kenya, Nigeria, South Africa and Tanzania.

The E-MOTIVE project was supported by a grant from the Bill & Melinda Gates Foundation.

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Notes for editors

  • For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7920 405040.
  • The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 6,500 international students from over 150 countries.
  • The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between seven organisations who collaborate to bring healthcare innovations through to clinical application:
    • University of Birmingham
    • University Hospitals Birmingham NHS Foundation Trust
    • Birmingham Women's and Children's Hospitals NHS Foundation Trust
    • Aston University
    • The Royal Orthopaedic Hospital NHS Foundation Trust
    • Sandwell and West Birmingham Hospitals NHS Trust
    • West Midlands Academic Health Science Network
    • Birmingham and Solihull Mental Health NHS Foundation Trust

Featured staff

  • Professor Arri Coomarasamy

    Professor of Gynaecology and Reproductive Medicine

    Staff profile for Professor Arri Coomarasamy, Professor of Gynaecology and Reproductive Medicine at the Department of Metabolism and Systems Science, and Director of the Tommy's National Centre for Miscarriage Research.

    Phone: +44(0)121 371 8202 PA to Professor Coomarasamy
    Email: a.coomarasamy@bham.ac.uk

  • Dr Adam Devall

    Associate Professor of Maternal Health Clinical Trials

    Staff profile for Dr Adam Devall, Associate Professor of Maternal Health Clinical Trials in the Department of Metabolism and Systems Science, University of Birmingham.

    Email: a.j.devall@bham.ac.uk

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