Global research priorities for intrauterine suction and sponge tools for postpartum haemorrhage management in low-income and middle-income countries: a modified Delphi approach.

Introduction: Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality and morbidity globally. Innovative PPH management tools have emerged using suction and sponge tamponade but currently lack substantial evidence. Broader understanding and collaborative research prioritisation are needed, especially in low-income and middle-income countries (LMICs), where the burden of PPH-related mortality is highest. We aimed to describe the current state of evidence and to solicit stakeholder input to identify research priorities related to emerging tools for PPH management. Methods: We used a four-phase modified Delphi approach to identify research priorities for emerging suction and sponge tools. In phase 1, we conducted a literature review and key informant interviews (KIIs) with 19 stakeholders. In phase 2, we distributed an online survey, receiving 66 responses. In phase 3, we virtually convened an expert panel of stakeholders (n=24) and a separate midwife-only focus group to discuss preliminary results and draft research questions. In phase 4, we surveyed our expert panel (n=37) for prioritisation of research questions. Surveys were disseminated via Research Electronic Data Capture while KIIs and the expert convening were held virtually. Results: Participants included clinicians, researchers, policy-makers, funders and tool developers from high-income and LMIC settings. The prioritisation process narrowed our focus from six tools to four, all of which were top-ranked priorities in phase 4. Stakeholders emphasised efficacy research in comprehensive emergency obstetric and newborn care facilities. Stakeholders stressed the importance of understanding adverse event risks. The urgency in conducting research on cost, provider ease of use and acceptability and patient experience differed between individuals from high-income versus LMIC settings. Conclusion: All four tools prioritised in this process have the potential to improve PPH management in LMICs. A coordinated research agenda is necessary to confirm safety and efficacy and to determine which tools are most appropriate for specific LMIC settings.