Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South Africa.
Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2023 Dec 4;113(12):24. doi: 10.7196/SAMJ.2023.v113i12.1164.
Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service.
产后出血是南非可预防产妇死亡的主要原因。在产后出血管理方面的重大突破中，E-MOTIVE 试验发现，在尼日利亚、肯尼亚、坦桑尼亚和南非的 78 家医院中，一种多方面的卫生服务干预措施将阴道分娩后的严重产后出血减少了 60%。E-MOTIVE 方法包括在分娩后最初的 1 小时内每 15 分钟监测客观的失血量，以早期发现产后出血并触发一线治疗措施，包括按摩子宫、催产素输注、氨甲环酸输注、静脉晶体液、检查病因、排空膀胱，如果需要，还需要升级治疗。E-MOTIVE 被整合到现有的管理产科急症的基本步骤算法中。试验设置中的某些与研究相关的元素无法在常规实践中复制。因此，我们需要制定本地策略，以确保干预的基本临床要素得到实施。潜在的策略包括将 E-MOTIVE 原则纳入国家指南、持续的培训策略以及确保所有设施都配备必要的药物、设备和授权。这一突破性干预措施为南非的妇女带来了希望，需要在国家范围内制定有目的、协调一致的实施策略，以覆盖卫生服务的各个层面。
