Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa
Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nig...
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| Format: | Article |
| Language: | English |
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South African Medical Association
2023-12-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/1164 |
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| author | M Singata-Madliki S Fawcus N Moran E Arends E Muller S Mandondo G J Hofmeyr |
| author_facet | M Singata-Madliki S Fawcus N Moran E Arends E Muller S Mandondo G J Hofmeyr |
| author_sort | M Singata-Madliki |
| collection | DOAJ |
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Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service.
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| format | Article |
| id | doaj-art-d0aa30762b5e4c4aae32fd596c6e314e |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-d0aa30762b5e4c4aae32fd596c6e314e2025-02-10T12:26:36ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352023-12-011131210.7196/SAMJ.2023.v113i12.1164Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South AfricaM Singata-Madliki0S Fawcus1N Moran2E Arends3E Muller4S Mandondo5G J Hofmeyr6Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South AfricaDepartment of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South AfricaKwaZulu-Natal Department of Health; Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaRetired: Western Cape Department of Health, South AfricaEffective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South AfricaEastern Cape Department of Health, East London, South AfricaEffective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South Africa; Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service. https://samajournals.co.za/index.php/samj/article/view/1164Postpartum haemorrhagePPHE-MOTIVE |
| spellingShingle | M Singata-Madliki S Fawcus N Moran E Arends E Muller S Mandondo G J Hofmeyr Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa South African Medical Journal Postpartum haemorrhage PPH E-MOTIVE |
| title | Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa |
| title_full | Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa |
| title_fullStr | Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa |
| title_full_unstemmed | Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa |
| title_short | Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa |
| title_sort | implementing e motive for detection and treatment of postpartum haemorrhage in south africa |
| topic | Postpartum haemorrhage PPH E-MOTIVE |
| url | https://samajournals.co.za/index.php/samj/article/view/1164 |
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