Findings From Stakeholder Consultation and Design Workshops and Country-Specific Adaptations
E-MOTIVE Intervention | Intervention/Implementation Strategy Summary | Workshop Findings | Country-Specific Adaptations |
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PPH detection:Calibrated drape |
A calibrated drape will be tied around the woman’s waist after the baby is born to collect blood loss for the first hour after birth; if bleeding continued beyond the first hour, blood loss will be collected for a second hour.The calibrated drape includes 2 trigger lines at 300 ml and 500 ml of blood loss.Monitor vital signs (blood pressure and pulse rate), do clinical observations (uterine tone and vaginal blood flow) and take readings of calibration lines every 15 minutes and document it in patient notes. |
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Limited scope to change 300 ml and 500 ml trigger lines because it is fixed by trial protocol.As agreed, what clinical actions should occur at specific volumes of blood loss:For Nigeria, Tanzania, and Kenya, the criteria for triggering the bundle were:
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PPH treatment:MOTIVE bundle | Give all treatments in quick succession described as a “bundled approach” to managing PPH |
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Limited scope to change the bundle components because it is fixed by WHO recommendations4As needed, adapt existing local protocols so midwives can administer tranexamic acid.Address skillsets in training as required (see E-MOTIVE training below). |
Implementation Strategy | |||
E-MOTIVE Training | Training of on-site trainers provided by Jhpiegoa On-site trainers deliver a facility-based, hands-on approach of training to all nurses, midwives, and doctors working on maternity wards including follow-up (e.g., skills practice simulation drills). |
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PPH trolley or carry case | PPH trolley or carry case including a content checklist both to be provided by the trial program |
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Sites to select the type of PPH kit, e.g., carry case in smaller wards (in Kenya, Nigeria and Tanzania), PPH box/ compartment as part of existing obstetric emergency trolley (in South Africa).
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E-MOTIVE champion | Two staff per hospital of different clinical cadres (midwife, doctor) to lead and promote implementation of E-MOTIVE intervention and implementation strategies. |
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Audit and feedback |
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| Develop a simpler, less detailed format for sites and add preferred comparators (i.e., include all study sites in a country). |
Abbreviations: E-MOTIVE, early detection of postpartum hemorrhage using a calibrated drape; massage of uterus, oxytocic drugs administration, tranexamic acid administration, intravenous fluids administration, examination for identifying and managing the source of bleeding, and escalation to more advanced care, if bleeding continues despite treatment; PPH, postpartum hemorrhage; WHO, World Health Organization.
↵a Jhpiego is a nonprofit organization for international health affiliated with Johns Hopkins University (https://www.jhpiego.org/).
↵b Essential Steps in the Management of Obstetric Emergencies is a skills and drills program for all maternity staff developed in South Africa.