Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial
- Autores
- Mammoliti, Kristie Marie; Althabe, Fernando; Easter, Christina; Martin, James; Devall, Adam J.; Funmi, Adeosun Love; Yusuf, Rahmatu; Abubakar, Fatima; Arigbede, Lolade Christiana; Mugambi, JimKelly; 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; Fawcus, Sue; Moran, Neil; Gwako, George; Osoti, Alfred; Gallos, Ioannis; Coomarasamy, Arri
- Año de publicación
- 2025
- Idioma
- inglés
- Tipo de recurso
- artículo
- Estado
- versión publicada
- Descripción
- Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, particularly in low- and- middle-income countries. The E-MOTIVE trial demonstrated a 60% reduction in severe PPH and related complications with the E-MOTIVE intervention compared to usual care. This nested observational study explored clinical care practices between the time of vaginal birth and the removal of the obstetric drape. Specifically, we assessed the frequency of postpartum maternal assessments, including blood pressure, pulse, uterine tone, vaginal blood flow, and cumulative blood loss assessment—unique to the intervention. We also evaluated diagnostic methods, and blood loss thresholds used for PPH, and how these practices may have contributed to differences in PPH diagnosis and outcomes between E-MOTIVE intervention hospitals and usual care hospitals.Methods: This prospective observational study, nested within the E-MOTIVE trial, involved passive, direct observations of healthcare workers providing postpartum care to women and managing PPH across 78 hospitals in Nigeria, Kenya, Tanzania, and South Africa. We conducted a descriptive analysis of the frequency and timing of postpartum maternal assessments, diagnostic methods and blood loss thresholds used to diagnose PPH, comparing clinical practices between E-MOTIVE care and usual care.Results: Between June and December 2022, the study included 2,578 women at E-MOTIVE care hospitals and 2,834 at usual care hospitals. At E-MOTIVE hospitals, 88% (2,272/2,578) of women received at least one postpartum maternal assessment, 71% (1,825/2,578) at least two, 57% (1,479/2,578) at least three, and 48% (1,234/2,578) four, with assessments conducted earlier and more frequently than at usual care hospitals. Objective blood loss quantification improved diagnosis, with the most common method and blood loss threshold at E-MOTIVE hospitals being ≥300 mL plus at least one abnormal clinical sign, used in 47% (140/295) of PPHs. Postpartum haemorrhage was diagnosed earlier and more frequently at E-MOTIVE hospitals: 76% (223/295) within 30 min, 97% (287/295) within 60 min, and 100% 295/295) within 90 min (median: 17 min; IQR 11–30), compared to 54% (119/219), 79% (173/219), 96% (210/219) respectively, and 100% within 134 min in usual care (median: 26 min; IQR 13–56).Discussion: Frequent and timely postpartum maternal assessments, along with objective blood loss thresholds of with at least one abnormal clinical sign and ≥500 mL may enhance early PPH diagnosis. The first 90 min postpartum has been identified as a critical window for early diagnosis, termed the “Golden 90 min for PPH diagnosis.” Incorporating these insights into clinical training and guidelines may support improved maternal outcomes related to PPH.
Fil: Mammoliti, Kristie Marie. 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: Easter, Christina. University Of Birmingham;
Fil: Martin, James. University Of Birmingham;
Fil: Devall, Adam J.. University Of Birmingham;
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, JimKelly. 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. University of Cape Town; 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. University Of Kwazulu-natal; Sudáfrica
Fil: Fawcus, Sue. University of Cape Town; Sudáfrica
Fil: Moran, Neil. Kwazulu-natal Department Of Health; Sudáfrica. University Of Kwazulu-natal; Sudáfrica
Fil: Gwako, George. University Of Nairobi; Kenia
Fil: Osoti, Alfred. University Of Nairobi; Kenia
Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina
Fil: Coomarasamy, Arri. University of Oxford; Reino Unido - Materia
-
early postpartum haemorrhage
PPH
EMOTIVE - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
- Repositorio
.jpg)
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/291121
Ver los metadatos del registro completo
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Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trialMammoliti, Kristie MarieAlthabe, FernandoEaster, ChristinaMartin, JamesDevall, Adam J.Funmi, Adeosun LoveYusuf, RahmatuAbubakar, FatimaArigbede, Lolade ChristianaMugambi, JimKellyOyoo, PolycarpSambusa, MasumbukoBanda, AkwinataSamuels, FawziaWillemse, SaraKhambule, Sibongile DorisShu'aib, Hilal MukhtarWakili, Aminu AdoOkore, JenipherMwampashi, ArdSingata-Madliki, MandisaArends, EdnaMuller, ElaniGaladanci, HadizaQureshi, ZahidaAl-Beity, Fadhlun AlwyFawcus, SueMoran, NeilGwako, GeorgeOsoti, AlfredGallos, IoannisCoomarasamy, Arriearly postpartum haemorrhagePPHEMOTIVEhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, particularly in low- and- middle-income countries. The E-MOTIVE trial demonstrated a 60% reduction in severe PPH and related complications with the E-MOTIVE intervention compared to usual care. This nested observational study explored clinical care practices between the time of vaginal birth and the removal of the obstetric drape. Specifically, we assessed the frequency of postpartum maternal assessments, including blood pressure, pulse, uterine tone, vaginal blood flow, and cumulative blood loss assessment—unique to the intervention. We also evaluated diagnostic methods, and blood loss thresholds used for PPH, and how these practices may have contributed to differences in PPH diagnosis and outcomes between E-MOTIVE intervention hospitals and usual care hospitals.Methods: This prospective observational study, nested within the E-MOTIVE trial, involved passive, direct observations of healthcare workers providing postpartum care to women and managing PPH across 78 hospitals in Nigeria, Kenya, Tanzania, and South Africa. We conducted a descriptive analysis of the frequency and timing of postpartum maternal assessments, diagnostic methods and blood loss thresholds used to diagnose PPH, comparing clinical practices between E-MOTIVE care and usual care.Results: Between June and December 2022, the study included 2,578 women at E-MOTIVE care hospitals and 2,834 at usual care hospitals. At E-MOTIVE hospitals, 88% (2,272/2,578) of women received at least one postpartum maternal assessment, 71% (1,825/2,578) at least two, 57% (1,479/2,578) at least three, and 48% (1,234/2,578) four, with assessments conducted earlier and more frequently than at usual care hospitals. Objective blood loss quantification improved diagnosis, with the most common method and blood loss threshold at E-MOTIVE hospitals being ≥300 mL plus at least one abnormal clinical sign, used in 47% (140/295) of PPHs. Postpartum haemorrhage was diagnosed earlier and more frequently at E-MOTIVE hospitals: 76% (223/295) within 30 min, 97% (287/295) within 60 min, and 100% 295/295) within 90 min (median: 17 min; IQR 11–30), compared to 54% (119/219), 79% (173/219), 96% (210/219) respectively, and 100% within 134 min in usual care (median: 26 min; IQR 13–56).Discussion: Frequent and timely postpartum maternal assessments, along with objective blood loss thresholds of with at least one abnormal clinical sign and ≥500 mL may enhance early PPH diagnosis. The first 90 min postpartum has been identified as a critical window for early diagnosis, termed the “Golden 90 min for PPH diagnosis.” Incorporating these insights into clinical training and guidelines may support improved maternal outcomes related to PPH.Fil: Mammoliti, Kristie Marie. 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: Easter, Christina. University Of Birmingham;Fil: Martin, James. University Of Birmingham;Fil: Devall, Adam J.. University Of Birmingham;Fil: Funmi, Adeosun Love. Bayero University; NigeriaFil: Yusuf, Rahmatu. Bayero University; NigeriaFil: Abubakar, Fatima. Bayero University; NigeriaFil: Arigbede, Lolade Christiana. Bayero University; NigeriaFil: Mugambi, JimKelly. 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; Sudáfrica. University of Cape Town; 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. University Of Kwazulu-natal; SudáfricaFil: Fawcus, Sue. University of Cape Town; SudáfricaFil: Moran, Neil. Kwazulu-natal Department Of Health; Sudáfrica. University Of Kwazulu-natal; SudáfricaFil: Gwako, George. University Of Nairobi; KeniaFil: Osoti, Alfred. University Of Nairobi; KeniaFil: Gallos, Ioannis. Organizacion Mundial de la Salud; ArgentinaFil: Coomarasamy, Arri. University of Oxford; Reino UnidoFrontiers Media2025-11info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/291121Mammoliti, Kristie Marie; Althabe, Fernando; Easter, Christina; Martin, James; Devall, Adam J.; et al.; Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial; Frontiers Media; Frontiers in Global Women's Health; 6; 11-2025; 1-122673-5059CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://www.frontiersin.org/articles/10.3389/fgwh.2025.1527261/fullinfo:eu-repo/semantics/altIdentifier/doi/10.3389/fgwh.2025.1527261info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T15:48:36Zoai:ri.conicet.gov.ar:11336/291121instacron: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 15:48:37.276CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
| dc.title.none.fl_str_mv |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial |
| title |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial |
| spellingShingle |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial Mammoliti, Kristie Marie early postpartum haemorrhage PPH EMOTIVE |
| title_short |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial |
| title_full |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial |
| title_fullStr |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial |
| title_full_unstemmed |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial |
| title_sort |
Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial |
| dc.creator.none.fl_str_mv |
Mammoliti, Kristie Marie Althabe, Fernando Easter, Christina Martin, James Devall, Adam J. Funmi, Adeosun Love Yusuf, Rahmatu Abubakar, Fatima Arigbede, Lolade Christiana Mugambi, JimKelly 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 Fawcus, Sue Moran, Neil Gwako, George Osoti, Alfred Gallos, Ioannis Coomarasamy, Arri |
| author |
Mammoliti, Kristie Marie |
| author_facet |
Mammoliti, Kristie Marie Althabe, Fernando Easter, Christina Martin, James Devall, Adam J. Funmi, Adeosun Love Yusuf, Rahmatu Abubakar, Fatima Arigbede, Lolade Christiana Mugambi, JimKelly 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 Fawcus, Sue Moran, Neil Gwako, George Osoti, Alfred Gallos, Ioannis Coomarasamy, Arri |
| author_role |
author |
| author2 |
Althabe, Fernando Easter, Christina Martin, James Devall, Adam J. Funmi, Adeosun Love Yusuf, Rahmatu Abubakar, Fatima Arigbede, Lolade Christiana Mugambi, JimKelly 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 Fawcus, Sue Moran, Neil Gwako, George Osoti, Alfred 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 |
| dc.subject.none.fl_str_mv |
early postpartum haemorrhage PPH EMOTIVE |
| topic |
early postpartum haemorrhage 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 |
Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, particularly in low- and- middle-income countries. The E-MOTIVE trial demonstrated a 60% reduction in severe PPH and related complications with the E-MOTIVE intervention compared to usual care. This nested observational study explored clinical care practices between the time of vaginal birth and the removal of the obstetric drape. Specifically, we assessed the frequency of postpartum maternal assessments, including blood pressure, pulse, uterine tone, vaginal blood flow, and cumulative blood loss assessment—unique to the intervention. We also evaluated diagnostic methods, and blood loss thresholds used for PPH, and how these practices may have contributed to differences in PPH diagnosis and outcomes between E-MOTIVE intervention hospitals and usual care hospitals.Methods: This prospective observational study, nested within the E-MOTIVE trial, involved passive, direct observations of healthcare workers providing postpartum care to women and managing PPH across 78 hospitals in Nigeria, Kenya, Tanzania, and South Africa. We conducted a descriptive analysis of the frequency and timing of postpartum maternal assessments, diagnostic methods and blood loss thresholds used to diagnose PPH, comparing clinical practices between E-MOTIVE care and usual care.Results: Between June and December 2022, the study included 2,578 women at E-MOTIVE care hospitals and 2,834 at usual care hospitals. At E-MOTIVE hospitals, 88% (2,272/2,578) of women received at least one postpartum maternal assessment, 71% (1,825/2,578) at least two, 57% (1,479/2,578) at least three, and 48% (1,234/2,578) four, with assessments conducted earlier and more frequently than at usual care hospitals. Objective blood loss quantification improved diagnosis, with the most common method and blood loss threshold at E-MOTIVE hospitals being ≥300 mL plus at least one abnormal clinical sign, used in 47% (140/295) of PPHs. Postpartum haemorrhage was diagnosed earlier and more frequently at E-MOTIVE hospitals: 76% (223/295) within 30 min, 97% (287/295) within 60 min, and 100% 295/295) within 90 min (median: 17 min; IQR 11–30), compared to 54% (119/219), 79% (173/219), 96% (210/219) respectively, and 100% within 134 min in usual care (median: 26 min; IQR 13–56).Discussion: Frequent and timely postpartum maternal assessments, along with objective blood loss thresholds of with at least one abnormal clinical sign and ≥500 mL may enhance early PPH diagnosis. The first 90 min postpartum has been identified as a critical window for early diagnosis, termed the “Golden 90 min for PPH diagnosis.” Incorporating these insights into clinical training and guidelines may support improved maternal outcomes related to PPH. Fil: Mammoliti, Kristie Marie. 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: Easter, Christina. University Of Birmingham; Fil: Martin, James. University Of Birmingham; Fil: Devall, Adam J.. University Of Birmingham; 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, JimKelly. 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. University of Cape Town; 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. University Of Kwazulu-natal; Sudáfrica Fil: Fawcus, Sue. University of Cape Town; Sudáfrica Fil: Moran, Neil. Kwazulu-natal Department Of Health; Sudáfrica. University Of Kwazulu-natal; Sudáfrica Fil: Gwako, George. University Of Nairobi; Kenia Fil: Osoti, Alfred. University Of Nairobi; Kenia Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina Fil: Coomarasamy, Arri. University of Oxford; Reino Unido |
| description |
Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, particularly in low- and- middle-income countries. The E-MOTIVE trial demonstrated a 60% reduction in severe PPH and related complications with the E-MOTIVE intervention compared to usual care. This nested observational study explored clinical care practices between the time of vaginal birth and the removal of the obstetric drape. Specifically, we assessed the frequency of postpartum maternal assessments, including blood pressure, pulse, uterine tone, vaginal blood flow, and cumulative blood loss assessment—unique to the intervention. We also evaluated diagnostic methods, and blood loss thresholds used for PPH, and how these practices may have contributed to differences in PPH diagnosis and outcomes between E-MOTIVE intervention hospitals and usual care hospitals.Methods: This prospective observational study, nested within the E-MOTIVE trial, involved passive, direct observations of healthcare workers providing postpartum care to women and managing PPH across 78 hospitals in Nigeria, Kenya, Tanzania, and South Africa. We conducted a descriptive analysis of the frequency and timing of postpartum maternal assessments, diagnostic methods and blood loss thresholds used to diagnose PPH, comparing clinical practices between E-MOTIVE care and usual care.Results: Between June and December 2022, the study included 2,578 women at E-MOTIVE care hospitals and 2,834 at usual care hospitals. At E-MOTIVE hospitals, 88% (2,272/2,578) of women received at least one postpartum maternal assessment, 71% (1,825/2,578) at least two, 57% (1,479/2,578) at least three, and 48% (1,234/2,578) four, with assessments conducted earlier and more frequently than at usual care hospitals. Objective blood loss quantification improved diagnosis, with the most common method and blood loss threshold at E-MOTIVE hospitals being ≥300 mL plus at least one abnormal clinical sign, used in 47% (140/295) of PPHs. Postpartum haemorrhage was diagnosed earlier and more frequently at E-MOTIVE hospitals: 76% (223/295) within 30 min, 97% (287/295) within 60 min, and 100% 295/295) within 90 min (median: 17 min; IQR 11–30), compared to 54% (119/219), 79% (173/219), 96% (210/219) respectively, and 100% within 134 min in usual care (median: 26 min; IQR 13–56).Discussion: Frequent and timely postpartum maternal assessments, along with objective blood loss thresholds of with at least one abnormal clinical sign and ≥500 mL may enhance early PPH diagnosis. The first 90 min postpartum has been identified as a critical window for early diagnosis, termed the “Golden 90 min for PPH diagnosis.” Incorporating these insights into clinical training and guidelines may support improved maternal outcomes related to PPH. |
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2025 |
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2025-11 |
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http://hdl.handle.net/11336/291121 Mammoliti, Kristie Marie; Althabe, Fernando; Easter, Christina; Martin, James; Devall, Adam J.; et al.; Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial; Frontiers Media; Frontiers in Global Women's Health; 6; 11-2025; 1-12 2673-5059 CONICET Digital CONICET |
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http://hdl.handle.net/11336/291121 |
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Mammoliti, Kristie Marie; Althabe, Fernando; Easter, Christina; Martin, James; Devall, Adam J.; et al.; Clinical care processes for early postpartum haemorrhage diagnosis: a nested observational study within the E-MOTIVE trial; Frontiers Media; Frontiers in Global Women's Health; 6; 11-2025; 1-12 2673-5059 CONICET Digital CONICET |
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