Evidence map›Paper›PMID 40755244›Full record

Observational studyBJOG : an international journal of obstetrics and gynaecology2025

When Is Postpartum Haemorrhage Treatment Initiated? A Nested Observational Study Within the E-MOTIVE Trial.

Kristie-Marie Mammoliti, Fernando Althabe, Christina Easter, Adam Devall, James Martin, Adeosun Love Funmi, Rahmatu Yusuf, Fatima Abubakar, Lolade Christiana Arigbede, JimKelly Mugambi and 23 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BJOG : an international journal of obstetrics and gynaecology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

33 authors.

Kristie-Marie MammolitiCollege of Medicine and Health, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0003-3614-7453
Fernando AlthabeUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.ORCID https://orcid.org/0000-0002-7024-8701
Christina EasterCollege of Medicine and Health, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0002-7028-1421
Adam DevallCollege of Medicine and Health, University of Birmingham, Birmingham, UK.
James MartinCollege of Medicine and Health, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0002-6949-4200
Adeosun Love FunmiAfrican Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria.
Rahmatu YusufAfrican Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria.
Fatima AbubakarAfrican Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria.
Lolade Christiana ArigbedeAfrican Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria.
JimKelly MugambiDepartment of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Polycarp OyooDepartment of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Masumbuko SambusaDepartment of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Akwinata BandaDepartment of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Fawzia SamuelsDepartment of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa.
Sara WillemseDepartment of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa.
Sibongile Doris KhambuleEffective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Hilal Mukhtar Shu'aibAfrican Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria.
Aminu Ado WakiliAfrican Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria.
Jenipher OkoreDepartment of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Ard MwampashiDepartment of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Mandisa Singata-MadlikiEffective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Edna ArendsDepartment of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa.
Elani MullerEffective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Hadiza GaladanciAfrican Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria.
Zahida QureshiDepartment of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Fadhlun Alwy Al-BeityDepartment of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.ORCID https://orcid.org/0000-0003-2416-6876
G Justus HofmeyrEffective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa.ORCID https://orcid.org/0000-0002-3080-1007
Sue FawcusDepartment of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa.
Neil MoranKwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
George GwakoDepartment of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Alfred OsotiDepartment of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Ioannis GallosUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Arri CoomarasamyCollege of Medicine and Health, University of Birmingham, Birmingham, UK.

Funding

Ammalife 1120236Gates Foundation INV-001393World Health Organization 001
6 · The paper itself

Abstract

objectiveTo compare the frequency and timing of postpartum haemorrhage (PPH) treatment initiation between hospitals implementing the MOTIVE treatment bundle (which consisted of uterine Massage, Oxytocic drugs, Tranexamic acid, IntraVenous fluids and Examination) and those following usual care.

designNested prospective observational study.

settingHospitals in Nigeria, Kenya, Tanzania and South Africa participating in the E-MOTIVE trial. POPULATION OR SAMPLE: Healthcare workers treating PPH.

methodsBetween June and December 2022, we observed healthcare workers for 1-2 weeks in 39 E-MOTIVE and 39 usual care hospitals across Nigeria, Kenya, Tanzania, and South Africa managing vaginal birth and treating PPH. We descriptively compared the frequency and timing from PPH detection to treatment initiation of individual treatments and the MOTIVE bundle, between E-MOTIVE care and usual care.

resultsAmong 2578 observations in E-MOTIVE care hospitals, 295 (11%) PPHs were treated, and among 2834 observations in usual care hospitals, 219 (8%) PPHs were treated. In E-MOTIVE care hospitals, 97% (286/295) of women with PPH received the MOTIVE bundle, compared to 36% (79/219) in usual care. Median initiation times for the first component were similar (0 vs. 1 min), but E-MOTIVE care hospitals achieved faster initiation of all components (13 min, IQR 6-18) compared to usual care (18 min, IQR 10-25). In total, 79% (233/295) of women in E-MOTIVE care had all components initiated within 20 min, compared to 22% (48/219) in usual care.

conclusionsTimely and comprehensive management of PPH using the MOTIVE bundle, particularly initiating all components within 15-20 min, was commonly observed in the E-MOTIVE care hospitals. Scaling up E-MOTIVE care should emphasise timely bundle initiation to strengthen PPH treatment and improve maternal health outcomes in low-and-middle-income countries.

Indexed as

Patient Care BundlesPostpartum HemorrhageTime-to-TreatmentAdultFemaleHumansOxytocicsPregnancyProspective StudiesOxytocicsMOTIVE bundlepostpartum haemorrhagePPHPPH treatmentPPH treatment bundlesub‐Saharan Africa

Identifiers

PMID40755244
PMCPMC12411655

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.