Early detection and bundled treatment of postpartum haemorrhage reduce risk of complications: NEJM

There is an increased risk of complications due to Delays in detecting and managing postpartum haemorrhage. A blood-collection drape provides objective, accurate, and early diagnosis, and inconsistent/delayed use of effective interventions may be able to be addressed by a treatment bundle.

Considering this background, researchers performed an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum haemorrhage in patients having a vaginal delivery. This study measured severe postpartum haemorrhage (blood loss, ≥1000 ml), laparotomy, or maternal death from bleeding. The secondary outcomes were the detection of postpartum haemorrhage and adherence to the treatment bundle.

Study Group details are:

Intervention group: A calibrated blood-collection drape for detecting postpartum haemorrhage early and a bundle of first-response treatments like uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation, supported by an implementation strategy.

Control group: Hospitals provided usual care.

The results of the study are:

• Eighty secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania were included.
• Two hundred ten thousand one hundred thirty-two patients who underwent vaginal delivery were randomly assigned to the intervention group and usual-care group.
• In the intervention and control groups, primary-outcome events occurred in 1.6% and 4.3 % of the patients, respectively, with a risk ratio of 0.40.
• 93.1 % and 51.1 % of patients in the intervention and usual care group had Postpartum haemorrhage detected with a rate ratio of 1.58.
• The treatment bundle was used in 91.2% and 19.4%, respectively, with a rate ratio of 4.94.

Concluding further, early detection of postpartum haemorrhage and bundled treatment lowers the risk of the primary outcome, a composite of severe postpartum haemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having a vaginal delivery.

As acknowledged, the study by Bill and Melinda Gates Foundation

Further reading:

https://www.nejm.org/doi/full/10.1056/NEJMoa2303966