Early Detection and Treatment of Postpartum Hemorrhage Using the E-MOTIVE Intervention: A Before-and-After Implementation Study in Pakistan [ID 1301]

INTRODUCTION: Postpartum hemorrhage (PPH) is the leading cause (41%) of maternal mortality in Pakistan with 75,000 deaths reported worldwide annually, with 90% being preventable. The major challenges are 1) failure to detect PPH, and 2) delayed or inconsistent use of lifesaving interventions. The E-MOTIVE trial showed that early detection (E) of PPH using calibrated drapes and bundled treatment (MOTIVE) led to a 60% reduction in the composite outcome (severe PPH, laparotomy for bleeding, or maternal death from bleeding) in the E-MOTIVE arm compared to usual care. Pakistan conducted an implementation study of E-MOTIVE strategies. METHODS: A before-and-after implementation study was conducted in eight secondary care health facilities providing comprehensive care: a baseline phase (October 2022 to March 2023) with usual care and dissemination of current guidelines, a 2-month transition, and 3 months (December 2023 to March 2024) of implementation of E-MOTIVE. Intervention was early detection using calibrated drapes and treatment with MOTIVE bundle (massage of uterus, oxytocic drugs, tranexamic acid, IV fluids, and examination and escalation) given in 15 minutes. Primary outcomes were PPH detection rate and bundle compliance. Secondary outcomes included the above composite outcome. RESULTS: There was a total of 9,033 vaginal births in the baseline and 5,089 in the implementation phase. The postpartum hemorrhage detection rate was 100% (109/109) as compared to 50.9% (534/1,050) in baseline (RR 1.99 [1.01, 3.92] 95% CI; P =.047). Bundle compliance was 100% versus 40.8% ( P =.023). The composite outcome reduced to 2 (<0.1%) from 183 (2.0%) (RR 0.03 [0.01, 0.13] 95% CI). CONCLUSIONS/IMPLICATIONS: The E-MOTIVE bundle is very effective in saving lives from PPH and can be implemented successfully in a South Asian setting.