An exploration of detection and management practices for postpartum haemorrhage in low- and middle-income countries: a quantitative survey

Thomas, Eleanor Rose (2024). An exploration of detection and management practices for postpartum haemorrhage in low- and middle-income countries: a quantitative survey. University of Birmingham. M.Sc.

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Abstract

Introduction As the leading cause of maternal mortality worldwide, postpartum haemorrhage (PPH) accounts for 27% of maternal deaths each year. With timely detection and management, the majority of PPH-related maternal deaths could be avoided or prevented. One method which could enable this is PPH-related clinical care bundles: a set of three to five discrete evidence-based clinical interventions delivered concurrently or in quick succession. The present study aimed to explore how primary PPH is currently detected and managed during vaginal birth at the E-MOTIVE trial facilities, to what extent the components of the new E-MOTIVE bundle are currently implemented within trial facilities, and what factors influence current PPH detection and management, and the implementation of the E-MOTIVE bundle.

Methods An electronic quantitative survey was conducted in health facilities across four countries: Kenya, Nigeria, South Africa and Tanzania, all of which were selected for participation in the E-MOTIVE trial. In total, 1,009 healthcare professionals completed the survey across 91 trial facilities. Data were analysed descriptively.

Results Visual estimation was the most commonly reported method of blood loss measurement by participants (n=885, 89.5%). Amongst those who indicated that detection of PPH was part of their clinical role, 21.8% (n=216) reported that they use an obstetric drape. Current performance of the E-MOTIVE bundle components varied, with 93.0% (n=929) of participants regularly performing uterine Massage, 92.7% (n=925) administering Oxytocin, 47.8% (n=477) administering Tranexamic acid, 90.8% (n=907) administering IV fluids, and 55.6% (n=555) performing Examination of the genital tract in the delivery room. When exploring methods to improve the detection and management of PPH, 96.0% (n=949) of participants agreed or strongly agreed that they intend to improve their knowledge of PPH. Participants indicated that improving team working (n=838, 90.4%), increasing the availability of supplies (n=757, 81.7%), having all the required supplies in one place (n=744, 80.3%), and more training (n=714, 77.1%), would make it easier to perform multiple PPH management interventions together in a bundle.

Conclusions This research outlines the current PPH detection and management practices of healthcare professionals working in the E-MOTIVE trial facilities. Differences between current practice and the target E-MOTIVE intervention were identified. Current barriers and enablers to the application of the intervention were discussed, and implementation strategies to support the E-MOTIVE bundle are suggested. Future research may further explore descriptive differences found at the country and cadre level.

Type of Work:

Thesis (Masters by Research > M.Sc.)

Award Type:

Masters by Research > M.Sc.

Supervisor(s):