Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage

Abstract

(N Engl J Med. 2023;389:11–21) Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide despite published recommendations from the World Health Organization (WHO) on prevention and treatment. There are challenges in implementing the PPH recommendations. Delay in detection as well as delay in treatment of PPH are 2 reasons the maternal death rate is high. One reason for the delay in detection is due to the ongoing use of visual estimation of blood loss, which often inaccurately underestimates the amount of lost blood. More aggressive interventions for PPH may be delayed until earlier approaches have failed in stopping the blood loss. In some cases, no effective treatment is administered at all. Finally, although the WHO has given these recommendations, not all hospitals and/or medical professionals are implementing them. This study sought to understand whether a treatment bundle referred to as E-MOTIVE could improve early detection and treatment of PPH in patients with a vaginal birth.