When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial
- Autores
- Mammoliti, Kristie Marie; Martin, James; Devall, Adam; Easter, Christina; Althabe, Fernando; Funmi, Adeosun Love; Yusuf, Rahmatu; Abubakar, Fatima; Arigbede, Lolade Christiana; Mugambi, Jim Kelly; Oyoo, Polycarp; Sambusa, Masumbuko; Banda, Akwinata; Samuels, Fawzia; Willemse, Sara; Khambule, Sibongile Doris; Shu'aib, Hilal Mukhtar; Wakili, Aminu Ado; Okore, Jenipher; Mwampashi, Ard; Singata-Madliki, Mandisa; Arends, Edna; Muller, Elani; Galadanci, Hadiza; Qureshi, Zahida; Al-Beity, Fadhlun Alwy; Hofmeyr, G Justus; Fawcus, Sue; Moran, Neil; Osoti, Alfred; Gwako, George; Gallos, Ioannis; Coomarasamy, Arri
- Año de publicación
- 2025
- Idioma
- inglés
- Tipo de recurso
- artículo
- Estado
- versión publicada
- Descripción
- BackgroundThe definition of primary postpartum haemorrhage as blood loss of 500 mL or more within 24 h after vaginal birth underemphasises the early postpartum hours due to limited data on the timing of postpartum haemorrhage diagnosis. Understanding postpartum haemorrhage diagnosis timing and diagnostic methods is important for guiding diagnostic and therapeutic strategies. The E-MOTIVE trial evaluated early postpartum haemorrhage diagnosis and a bundled treatment approach, which resulted in a 60% relative reduction in adverse outcomes from bleeding compared with usual care. We aimed to compare timing from vaginal birth to postpartum haemorrhage diagnosis and the diagnostic methods used among four African countries implementing the intervention from the E-MOTIVE trial.MethodsNested within the E-MOTIVE trial (NCT04341662), we conducted direct observations of health-care workers providing clinical care to postpartum women at 39 hospitals implementing the E-MOTIVE intervention across Nigeria, Kenya, Tanzania, and South Africa. One to two weeks of continuous observations were conducted from vaginal birth up to 2 h, between June 27, and Dec 18, 2022. Health-care workers were trained to use clinical judgement (ie, heavy vaginal blood loss, large blood clots expelled, or constant trickle) and various objective blood loss thresholds to diagnose postpartum haemorrhage. The objective blood loss thresholds used in Nigeria, Kenya, and Tanzania were 300 mL or more with at least one abnormal clinical sign (ie, pulse, blood pressure, uterine tone, and vaginal blood flow) or 500 mL or more. The objective blood loss threshold in South Africa was 500 mL or more. We descriptively analysed and compared timing from vaginal birth to postpartum haemorrhage diagnosis and diagnostic methods used between countries.FindingsOf 2578 women, 295 postpartum haemorrhages were diagnosed. The median time from vaginal birth to postpartum haemorrhage diagnosis was 15 min in Nigeria and Tanzania, 17 min in Kenya, and 30 min in South Africa. Diagnosis within 30 min ranged from 58% in South Africa to 86% in Tanzania. By 60 min, 96% to 100% of postpartum haemorrhages were diagnosed across all countries. All postpartum haemorrhages that required an intervention were diagnosed within 90 min. Nigeria, Kenya, and Tanzania commonly used blood loss of 300 mL or more combined with at least one abnormal clinical sign (47%, 65%, and 68%, respectively) while South Africa relied on a definition of 500 mL or more (81%) as the dominant diagnostic strategy.InterpretationIn countries where an objective blood loss threshold of 300 mL or more with at least one abnormal clinical sign was used, women received earlier interventions for postpartum bleeding, with a median time to diagnosis of 15–17 min. This was notably faster than in the country that predominantly used a 500 mL or more threshold, where the median time to diagnosis was 30 min. Regardless of whether the threshold was 300 mL or more with abnormal clinical signs or 500 mL or more alone, all postpartum haemorrhages were diagnosed within 90 min of vaginal birth.
Fil: Mammoliti, Kristie Marie. University Of Birmingham;
Fil: Martin, James. University Of Birmingham;
Fil: Devall, Adam. University Of Birmingham;
Fil: Easter, Christina. University Of Birmingham;
Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Funmi, Adeosun Love. Bayero University; Nigeria
Fil: Yusuf, Rahmatu. Bayero University; Nigeria
Fil: Abubakar, Fatima. Bayero University; Nigeria
Fil: Arigbede, Lolade Christiana. Bayero University; Nigeria
Fil: Mugambi, Jim Kelly. University Of Nairobi; Kenia
Fil: Oyoo, Polycarp. University Of Nairobi; Kenia
Fil: Sambusa, Masumbuko. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Banda, Akwinata. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Samuels, Fawzia. University of Cape Town; Sudáfrica
Fil: Willemse, Sara. University of Cape Town; Sudáfrica
Fil: Khambule, Sibongile Doris. University of the Witwatersrand; Sudáfrica
Fil: Shu'aib, Hilal Mukhtar. Bayero University; Nigeria
Fil: Wakili, Aminu Ado. Bayero University; Nigeria
Fil: Okore, Jenipher. University Of Nairobi; Kenia
Fil: Mwampashi, Ard. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Singata-Madliki, Mandisa. University of the Witwatersrand; Sudáfrica
Fil: Arends, Edna. University of Cape Town; Sudáfrica
Fil: Muller, Elani. University of the Witwatersrand; Sudáfrica
Fil: Galadanci, Hadiza. Bayero University; Nigeria
Fil: Qureshi, Zahida. University Of Nairobi; Kenia
Fil: Al-Beity, Fadhlun Alwy. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Hofmeyr, G Justus. University of the Witwatersrand; Sudáfrica
Fil: Fawcus, Sue. University of Cape Town; Sudáfrica
Fil: Moran, Neil. University of the Witwatersrand; Sudáfrica
Fil: Osoti, Alfred. University Of Nairobi; Kenia
Fil: Gwako, George. University Of Nairobi; Kenia
Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina
Fil: Coomarasamy, Arri. University of Oxford; Reino Unido - Materia
-
postpartum haemorrhages
DIAGNOSES
PPH
EMOTIVE - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by/2.5/ar/
- Repositorio
.jpg)
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/291120
Ver los metadatos del registro completo
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When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trialMammoliti, Kristie MarieMartin, JamesDevall, AdamEaster, ChristinaAlthabe, FernandoFunmi, Adeosun LoveYusuf, RahmatuAbubakar, FatimaArigbede, Lolade ChristianaMugambi, Jim KellyOyoo, PolycarpSambusa, MasumbukoBanda, AkwinataSamuels, FawziaWillemse, SaraKhambule, Sibongile DorisShu'aib, Hilal MukhtarWakili, Aminu AdoOkore, JenipherMwampashi, ArdSingata-Madliki, MandisaArends, EdnaMuller, ElaniGaladanci, HadizaQureshi, ZahidaAl-Beity, Fadhlun AlwyHofmeyr, G JustusFawcus, SueMoran, NeilOsoti, AlfredGwako, GeorgeGallos, IoannisCoomarasamy, Arripostpartum haemorrhagesDIAGNOSESPPHEMOTIVEhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3BackgroundThe definition of primary postpartum haemorrhage as blood loss of 500 mL or more within 24 h after vaginal birth underemphasises the early postpartum hours due to limited data on the timing of postpartum haemorrhage diagnosis. Understanding postpartum haemorrhage diagnosis timing and diagnostic methods is important for guiding diagnostic and therapeutic strategies. The E-MOTIVE trial evaluated early postpartum haemorrhage diagnosis and a bundled treatment approach, which resulted in a 60% relative reduction in adverse outcomes from bleeding compared with usual care. We aimed to compare timing from vaginal birth to postpartum haemorrhage diagnosis and the diagnostic methods used among four African countries implementing the intervention from the E-MOTIVE trial.MethodsNested within the E-MOTIVE trial (NCT04341662), we conducted direct observations of health-care workers providing clinical care to postpartum women at 39 hospitals implementing the E-MOTIVE intervention across Nigeria, Kenya, Tanzania, and South Africa. One to two weeks of continuous observations were conducted from vaginal birth up to 2 h, between June 27, and Dec 18, 2022. Health-care workers were trained to use clinical judgement (ie, heavy vaginal blood loss, large blood clots expelled, or constant trickle) and various objective blood loss thresholds to diagnose postpartum haemorrhage. The objective blood loss thresholds used in Nigeria, Kenya, and Tanzania were 300 mL or more with at least one abnormal clinical sign (ie, pulse, blood pressure, uterine tone, and vaginal blood flow) or 500 mL or more. The objective blood loss threshold in South Africa was 500 mL or more. We descriptively analysed and compared timing from vaginal birth to postpartum haemorrhage diagnosis and diagnostic methods used between countries.FindingsOf 2578 women, 295 postpartum haemorrhages were diagnosed. The median time from vaginal birth to postpartum haemorrhage diagnosis was 15 min in Nigeria and Tanzania, 17 min in Kenya, and 30 min in South Africa. Diagnosis within 30 min ranged from 58% in South Africa to 86% in Tanzania. By 60 min, 96% to 100% of postpartum haemorrhages were diagnosed across all countries. All postpartum haemorrhages that required an intervention were diagnosed within 90 min. Nigeria, Kenya, and Tanzania commonly used blood loss of 300 mL or more combined with at least one abnormal clinical sign (47%, 65%, and 68%, respectively) while South Africa relied on a definition of 500 mL or more (81%) as the dominant diagnostic strategy.InterpretationIn countries where an objective blood loss threshold of 300 mL or more with at least one abnormal clinical sign was used, women received earlier interventions for postpartum bleeding, with a median time to diagnosis of 15–17 min. This was notably faster than in the country that predominantly used a 500 mL or more threshold, where the median time to diagnosis was 30 min. Regardless of whether the threshold was 300 mL or more with abnormal clinical signs or 500 mL or more alone, all postpartum haemorrhages were diagnosed within 90 min of vaginal birth.Fil: Mammoliti, Kristie Marie. University Of Birmingham;Fil: Martin, James. University Of Birmingham;Fil: Devall, Adam. University Of Birmingham;Fil: Easter, Christina. University Of Birmingham;Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Funmi, Adeosun Love. Bayero University; NigeriaFil: Yusuf, Rahmatu. Bayero University; NigeriaFil: Abubakar, Fatima. Bayero University; NigeriaFil: Arigbede, Lolade Christiana. Bayero University; NigeriaFil: Mugambi, Jim Kelly. University Of Nairobi; KeniaFil: Oyoo, Polycarp. University Of Nairobi; KeniaFil: Sambusa, Masumbuko. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Banda, Akwinata. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Samuels, Fawzia. University of Cape Town; SudáfricaFil: Willemse, Sara. University of Cape Town; SudáfricaFil: Khambule, Sibongile Doris. University of the Witwatersrand; SudáfricaFil: Shu'aib, Hilal Mukhtar. Bayero University; NigeriaFil: Wakili, Aminu Ado. Bayero University; NigeriaFil: Okore, Jenipher. University Of Nairobi; KeniaFil: Mwampashi, Ard. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Singata-Madliki, Mandisa. University of the Witwatersrand; SudáfricaFil: Arends, Edna. University of Cape Town; SudáfricaFil: Muller, Elani. University of the Witwatersrand; SudáfricaFil: Galadanci, Hadiza. Bayero University; NigeriaFil: Qureshi, Zahida. University Of Nairobi; KeniaFil: Al-Beity, Fadhlun Alwy. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Hofmeyr, G Justus. University of the Witwatersrand; SudáfricaFil: Fawcus, Sue. University of Cape Town; SudáfricaFil: Moran, Neil. University of the Witwatersrand; SudáfricaFil: Osoti, Alfred. University Of Nairobi; KeniaFil: Gwako, George. University Of Nairobi; KeniaFil: Gallos, Ioannis. Organizacion Mundial de la Salud; ArgentinaFil: Coomarasamy, Arri. University of Oxford; Reino UnidoElsevier2025-11info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/291120Mammoliti, Kristie Marie; Martin, James; Devall, Adam; Easter, Christina; Althabe, Fernando; et al.; When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial; Elsevier; The Lancet Global Health; 13; 11; 11-2025; 1-92214-109XCONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S2214109X2500302Xinfo:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(25)00302-Xinfo:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T15:10:29Zoai:ri.conicet.gov.ar:11336/291120instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 15:10:29.745CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
| dc.title.none.fl_str_mv |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial |
| title |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial |
| spellingShingle |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial Mammoliti, Kristie Marie postpartum haemorrhages DIAGNOSES PPH EMOTIVE |
| title_short |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial |
| title_full |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial |
| title_fullStr |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial |
| title_full_unstemmed |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial |
| title_sort |
When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial |
| dc.creator.none.fl_str_mv |
Mammoliti, Kristie Marie Martin, James Devall, Adam Easter, Christina Althabe, Fernando Funmi, Adeosun Love Yusuf, Rahmatu Abubakar, Fatima Arigbede, Lolade Christiana Mugambi, Jim Kelly Oyoo, Polycarp Sambusa, Masumbuko Banda, Akwinata Samuels, Fawzia Willemse, Sara Khambule, Sibongile Doris Shu'aib, Hilal Mukhtar Wakili, Aminu Ado Okore, Jenipher Mwampashi, Ard Singata-Madliki, Mandisa Arends, Edna Muller, Elani Galadanci, Hadiza Qureshi, Zahida Al-Beity, Fadhlun Alwy Hofmeyr, G Justus Fawcus, Sue Moran, Neil Osoti, Alfred Gwako, George Gallos, Ioannis Coomarasamy, Arri |
| author |
Mammoliti, Kristie Marie |
| author_facet |
Mammoliti, Kristie Marie Martin, James Devall, Adam Easter, Christina Althabe, Fernando Funmi, Adeosun Love Yusuf, Rahmatu Abubakar, Fatima Arigbede, Lolade Christiana Mugambi, Jim Kelly Oyoo, Polycarp Sambusa, Masumbuko Banda, Akwinata Samuels, Fawzia Willemse, Sara Khambule, Sibongile Doris Shu'aib, Hilal Mukhtar Wakili, Aminu Ado Okore, Jenipher Mwampashi, Ard Singata-Madliki, Mandisa Arends, Edna Muller, Elani Galadanci, Hadiza Qureshi, Zahida Al-Beity, Fadhlun Alwy Hofmeyr, G Justus Fawcus, Sue Moran, Neil Osoti, Alfred Gwako, George Gallos, Ioannis Coomarasamy, Arri |
| author_role |
author |
| author2 |
Martin, James Devall, Adam Easter, Christina Althabe, Fernando Funmi, Adeosun Love Yusuf, Rahmatu Abubakar, Fatima Arigbede, Lolade Christiana Mugambi, Jim Kelly Oyoo, Polycarp Sambusa, Masumbuko Banda, Akwinata Samuels, Fawzia Willemse, Sara Khambule, Sibongile Doris Shu'aib, Hilal Mukhtar Wakili, Aminu Ado Okore, Jenipher Mwampashi, Ard Singata-Madliki, Mandisa Arends, Edna Muller, Elani Galadanci, Hadiza Qureshi, Zahida Al-Beity, Fadhlun Alwy Hofmeyr, G Justus Fawcus, Sue Moran, Neil Osoti, Alfred Gwako, George Gallos, Ioannis Coomarasamy, Arri |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
postpartum haemorrhages DIAGNOSES PPH EMOTIVE |
| topic |
postpartum haemorrhages DIAGNOSES PPH EMOTIVE |
| purl_subject.fl_str_mv |
https://purl.org/becyt/ford/3.3 https://purl.org/becyt/ford/3 |
| dc.description.none.fl_txt_mv |
BackgroundThe definition of primary postpartum haemorrhage as blood loss of 500 mL or more within 24 h after vaginal birth underemphasises the early postpartum hours due to limited data on the timing of postpartum haemorrhage diagnosis. Understanding postpartum haemorrhage diagnosis timing and diagnostic methods is important for guiding diagnostic and therapeutic strategies. The E-MOTIVE trial evaluated early postpartum haemorrhage diagnosis and a bundled treatment approach, which resulted in a 60% relative reduction in adverse outcomes from bleeding compared with usual care. We aimed to compare timing from vaginal birth to postpartum haemorrhage diagnosis and the diagnostic methods used among four African countries implementing the intervention from the E-MOTIVE trial.MethodsNested within the E-MOTIVE trial (NCT04341662), we conducted direct observations of health-care workers providing clinical care to postpartum women at 39 hospitals implementing the E-MOTIVE intervention across Nigeria, Kenya, Tanzania, and South Africa. One to two weeks of continuous observations were conducted from vaginal birth up to 2 h, between June 27, and Dec 18, 2022. Health-care workers were trained to use clinical judgement (ie, heavy vaginal blood loss, large blood clots expelled, or constant trickle) and various objective blood loss thresholds to diagnose postpartum haemorrhage. The objective blood loss thresholds used in Nigeria, Kenya, and Tanzania were 300 mL or more with at least one abnormal clinical sign (ie, pulse, blood pressure, uterine tone, and vaginal blood flow) or 500 mL or more. The objective blood loss threshold in South Africa was 500 mL or more. We descriptively analysed and compared timing from vaginal birth to postpartum haemorrhage diagnosis and diagnostic methods used between countries.FindingsOf 2578 women, 295 postpartum haemorrhages were diagnosed. The median time from vaginal birth to postpartum haemorrhage diagnosis was 15 min in Nigeria and Tanzania, 17 min in Kenya, and 30 min in South Africa. Diagnosis within 30 min ranged from 58% in South Africa to 86% in Tanzania. By 60 min, 96% to 100% of postpartum haemorrhages were diagnosed across all countries. All postpartum haemorrhages that required an intervention were diagnosed within 90 min. Nigeria, Kenya, and Tanzania commonly used blood loss of 300 mL or more combined with at least one abnormal clinical sign (47%, 65%, and 68%, respectively) while South Africa relied on a definition of 500 mL or more (81%) as the dominant diagnostic strategy.InterpretationIn countries where an objective blood loss threshold of 300 mL or more with at least one abnormal clinical sign was used, women received earlier interventions for postpartum bleeding, with a median time to diagnosis of 15–17 min. This was notably faster than in the country that predominantly used a 500 mL or more threshold, where the median time to diagnosis was 30 min. Regardless of whether the threshold was 300 mL or more with abnormal clinical signs or 500 mL or more alone, all postpartum haemorrhages were diagnosed within 90 min of vaginal birth. Fil: Mammoliti, Kristie Marie. University Of Birmingham; Fil: Martin, James. University Of Birmingham; Fil: Devall, Adam. University Of Birmingham; Fil: Easter, Christina. University Of Birmingham; Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Funmi, Adeosun Love. Bayero University; Nigeria Fil: Yusuf, Rahmatu. Bayero University; Nigeria Fil: Abubakar, Fatima. Bayero University; Nigeria Fil: Arigbede, Lolade Christiana. Bayero University; Nigeria Fil: Mugambi, Jim Kelly. University Of Nairobi; Kenia Fil: Oyoo, Polycarp. University Of Nairobi; Kenia Fil: Sambusa, Masumbuko. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Banda, Akwinata. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Samuels, Fawzia. University of Cape Town; Sudáfrica Fil: Willemse, Sara. University of Cape Town; Sudáfrica Fil: Khambule, Sibongile Doris. University of the Witwatersrand; Sudáfrica Fil: Shu'aib, Hilal Mukhtar. Bayero University; Nigeria Fil: Wakili, Aminu Ado. Bayero University; Nigeria Fil: Okore, Jenipher. University Of Nairobi; Kenia Fil: Mwampashi, Ard. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Singata-Madliki, Mandisa. University of the Witwatersrand; Sudáfrica Fil: Arends, Edna. University of Cape Town; Sudáfrica Fil: Muller, Elani. University of the Witwatersrand; Sudáfrica Fil: Galadanci, Hadiza. Bayero University; Nigeria Fil: Qureshi, Zahida. University Of Nairobi; Kenia Fil: Al-Beity, Fadhlun Alwy. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Hofmeyr, G Justus. University of the Witwatersrand; Sudáfrica Fil: Fawcus, Sue. University of Cape Town; Sudáfrica Fil: Moran, Neil. University of the Witwatersrand; Sudáfrica Fil: Osoti, Alfred. University Of Nairobi; Kenia Fil: Gwako, George. University Of Nairobi; Kenia Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina Fil: Coomarasamy, Arri. University of Oxford; Reino Unido |
| description |
BackgroundThe definition of primary postpartum haemorrhage as blood loss of 500 mL or more within 24 h after vaginal birth underemphasises the early postpartum hours due to limited data on the timing of postpartum haemorrhage diagnosis. Understanding postpartum haemorrhage diagnosis timing and diagnostic methods is important for guiding diagnostic and therapeutic strategies. The E-MOTIVE trial evaluated early postpartum haemorrhage diagnosis and a bundled treatment approach, which resulted in a 60% relative reduction in adverse outcomes from bleeding compared with usual care. We aimed to compare timing from vaginal birth to postpartum haemorrhage diagnosis and the diagnostic methods used among four African countries implementing the intervention from the E-MOTIVE trial.MethodsNested within the E-MOTIVE trial (NCT04341662), we conducted direct observations of health-care workers providing clinical care to postpartum women at 39 hospitals implementing the E-MOTIVE intervention across Nigeria, Kenya, Tanzania, and South Africa. One to two weeks of continuous observations were conducted from vaginal birth up to 2 h, between June 27, and Dec 18, 2022. Health-care workers were trained to use clinical judgement (ie, heavy vaginal blood loss, large blood clots expelled, or constant trickle) and various objective blood loss thresholds to diagnose postpartum haemorrhage. The objective blood loss thresholds used in Nigeria, Kenya, and Tanzania were 300 mL or more with at least one abnormal clinical sign (ie, pulse, blood pressure, uterine tone, and vaginal blood flow) or 500 mL or more. The objective blood loss threshold in South Africa was 500 mL or more. We descriptively analysed and compared timing from vaginal birth to postpartum haemorrhage diagnosis and diagnostic methods used between countries.FindingsOf 2578 women, 295 postpartum haemorrhages were diagnosed. The median time from vaginal birth to postpartum haemorrhage diagnosis was 15 min in Nigeria and Tanzania, 17 min in Kenya, and 30 min in South Africa. Diagnosis within 30 min ranged from 58% in South Africa to 86% in Tanzania. By 60 min, 96% to 100% of postpartum haemorrhages were diagnosed across all countries. All postpartum haemorrhages that required an intervention were diagnosed within 90 min. Nigeria, Kenya, and Tanzania commonly used blood loss of 300 mL or more combined with at least one abnormal clinical sign (47%, 65%, and 68%, respectively) while South Africa relied on a definition of 500 mL or more (81%) as the dominant diagnostic strategy.InterpretationIn countries where an objective blood loss threshold of 300 mL or more with at least one abnormal clinical sign was used, women received earlier interventions for postpartum bleeding, with a median time to diagnosis of 15–17 min. This was notably faster than in the country that predominantly used a 500 mL or more threshold, where the median time to diagnosis was 30 min. Regardless of whether the threshold was 300 mL or more with abnormal clinical signs or 500 mL or more alone, all postpartum haemorrhages were diagnosed within 90 min of vaginal birth. |
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2025 |
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2025-11 |
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http://hdl.handle.net/11336/291120 Mammoliti, Kristie Marie; Martin, James; Devall, Adam; Easter, Christina; Althabe, Fernando; et al.; When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial; Elsevier; The Lancet Global Health; 13; 11; 11-2025; 1-9 2214-109X CONICET Digital CONICET |
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http://hdl.handle.net/11336/291120 |
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Mammoliti, Kristie Marie; Martin, James; Devall, Adam; Easter, Christina; Althabe, Fernando; et al.; When are postpartum haemorrhages diagnosed? A nested observational study within the E-MOTIVE cluster-randomised trial; Elsevier; The Lancet Global Health; 13; 11; 11-2025; 1-9 2214-109X CONICET Digital CONICET |
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