Population
Patients undergoing vaginal delivery enrolled in the E-MOTIVE cluster-randomised trial in 80 hospitals across Kenya, Nigeria, South Africa and Tanzania (n= 210,132).
Intervention
Multicomponent clinical intervention, including a calibrated blood-collection drape for early detection of postpartum haemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy, (intervention group, 40 hospitals).
Comparison
Usual care, estimating blood loss visually and using various interventions for postpartum haemorrhage in accordance with local or national guidelines, (usual-care group, 40 hospitals).
Outcome
The primary outcome was a composite of severe postpartum haemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval (CI), [0.32, 0.50]). Postpartum haemorrhage was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI [1.41, 1.76]), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI [3.88, 6.28]).