Feasibility, acceptability, and effectiveness of the E-MOTIVE bundle intervention for early detection and management of postpartum hemorrhage in a low-middle-income country: implementation research.

backgroundPostpartum hemorrhage continues to be a leading cause of maternal mortality globally. Although the E-MOTIVE bundle is an innovative approach for the early detection and management of postpartum hemorrhage that reduces maternal mortality by as high as 60%, its universal implementation in clinical practice in low-middle-income countries remains low.

objectiveThis study aimed to determine the effectiveness and acceptability of the E-MOTIVE bundle intervention in Ethiopia. STUDY

designThis was an implementation research on the E-MOTIVE bundle intervention for the early detection and treatment of postpartum hemorrhage using a mixed-method study design (pre- and postintervention quantitative study and cross-sectional qualitative study) in Ethiopia for over 22 months (June 2023 to February 2025). The primary outcome of the study was the rate of severe postpartum hemorrhage. The secondary outcomes were the detection of postpartum hemorrhage complications (such as blood transfusion, maternal death, admission to a high-dependency unit, and estimated blood loss) and the acceptability of the E-MOTIVE bundle approach. The participants of the quantitative study included pregnant women who delivered vaginally at St. Paul's Hospital during the study period. Participants of the qualitative data were postpartum women who had the E-MOTIVE bundle approach applied during delivery, obstetrical care providers, maternity care coordinators, and representatives of nongovernmental organizations who focused on maternal care delivery. Quantitative data (including the characteristics of the E-MOTIVE bundle approach, occurrence of postpartum hemorrhage, and postpartum hemorrhage complication) were collected using a structured questionnaire, and qualitative data were collected using key informant interviews and focus group discussions (in-depth interviews and focused discussions focusing on the E-MOTIVE experience, attitude, and practice were conducted). Quantitative data were analyzed using simple descriptive statistics on IBM SPSS Statistics (version 23; IBM Corporation, Armonk, NY), and qualitative data were analyzed using thematic analysis on Scientific Software (ATLAS.ti.9.Ink; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany).

resultsThere were a total of 2500 and 2225 vaginal deliveries during the preintervention and postintervention periods, respectively. Compared with the preintervention period, there was a significant reduction in severe postpartum hemorrhage (25.0% in the preintervention period vs 13.5% in the postintervention period) and complications of postpartum hemorrhage, including maternal death (laparotomy: 5.0% in the preintervention period vs 1.0% in the postintervention period; maternal death: one maternal death in the preintervention period vs no encounter of maternal death in the postintervention period) in the postintervention period. From the qualitative data analysis, 3 overarching themes emerged: game-changer approach for the objective diagnosis of postpartum hemorrhage, opportunities for the scale-up of E-MOTIVE bundle intervention, and acceptability of the E-MOTIVE drape.

conclusionThe E-MOTIVE bundle intervention resulted in the reduction of severe postpartum hemorrhage and postpartum hemorrhage complications: no encounter of maternal death and few instances of surgical intervention to stop hemorrhage. It is feasible and has good acceptability by providers and mothers. Scale-up of the E-MOTIVE bundle intervention across low-middle-income countries is recommended.