Kristie-Marie Mammoliti, Fernando Althabe, Christina Easter, Adam Devall, James Martin, Adeosun Love Funmi, Rahmatu Yusuf, Fatima Abubakar, Lolade Christiana Arigbede, JimKelly Mugambi, Polycarp Oyoo, Masumbuko Sambusa, Akwinata Banda, Fawzia Samuels, Sara Willemse, Sibongile Doris Khambule, Hilal Mukhtar Shu'aib, Aminu Ado Wakili, Jenipher Okore, Ard Mwampashi, Mandisa Singata-Madliki, Edna Arends, Elani Muller, Hadiza Galadanci, Zahida Qureshi, Fadhlun Alwy Al-Beity, G. Justus Hofmeyr, Sue Fawcus, Neil Moran, George Gwako, Alfred Osoti, Ioannis Gallos, Arri Coomarasamy
{"title":"产后出血治疗何时开始？E-MOTIVE试验中的嵌套观察性研究。","authors":"Kristie-Marie Mammoliti, Fernando Althabe, Christina Easter, Adam Devall, James Martin, Adeosun Love Funmi, Rahmatu Yusuf, Fatima Abubakar, Lolade Christiana Arigbede, JimKelly Mugambi, Polycarp Oyoo, Masumbuko Sambusa, Akwinata Banda, Fawzia Samuels, Sara Willemse, Sibongile Doris Khambule, Hilal Mukhtar Shu'aib, Aminu Ado Wakili, Jenipher Okore, Ard Mwampashi, Mandisa Singata-Madliki, Edna Arends, Elani Muller, Hadiza Galadanci, Zahida Qureshi, Fadhlun Alwy Al-Beity, G. Justus Hofmeyr, Sue Fawcus, Neil Moran, George Gwako, Alfred Osoti, Ioannis Gallos, Arri Coomarasamy","doi":"10.1111/1471-0528.18293","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To compare the frequency and timing of postpartum haemorrhage (PPH) treatment initiation between hospitals implementing the MOTIVE treatment bundle (which consisted of uterine Massage, Oxytocic drugs, Tranexamic acid, IntraVenous fluids and Examination) and those following usual care.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Nested prospective observational study.</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>Hospitals in Nigeria, Kenya, Tanzania and South Africa participating in the E-MOTIVE trial.</p>\n </section>\n \n <section>\n \n <h3> Population or Sample</h3>\n \n <p>Healthcare workers treating PPH.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Between June and December 2022, we observed healthcare workers for 1–2 weeks in 39 E-MOTIVE and 39 usual care hospitals across Nigeria, Kenya, Tanzania, and South Africa managing vaginal birth and treating PPH. We descriptively compared the frequency and timing from PPH detection to treatment initiation of individual treatments and the MOTIVE bundle, between E-MOTIVE care and usual care.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 2578 observations in E-MOTIVE care hospitals, 295 (11%) PPHs were treated, and among 2834 observations in usual care hospitals, 219 (8%) PPHs were treated. In E-MOTIVE care hospitals, 97% (286/295) of women with PPH received the MOTIVE bundle, compared to 36% (79/219) in usual care. Median initiation times for the first component were similar (0 vs. 1 min), but E-MOTIVE care hospitals achieved faster initiation of all components (13 min, IQR 6–18) compared to usual care (18 min, IQR 10–25). In total, 79% (233/295) of women in E-MOTIVE care had all components initiated within 20 min, compared to 22% (48/219) in usual care.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Timely and comprehensive management of PPH using the MOTIVE bundle, particularly initiating all components within 15–20 min, was commonly observed in the E-MOTIVE care hospitals. Scaling up E-MOTIVE care should emphasise timely bundle initiation to strengthen PPH treatment and improve maternal health outcomes in low-and-middle-income countries.</p>\n </section>\n </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":"1664-1672"},"PeriodicalIF":4.3000,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18293","citationCount":"0","resultStr":"{\"title\":\"When Is Postpartum Haemorrhage Treatment Initiated? A Nested Observational Study Within the E-MOTIVE Trial\",\"authors\":\"Kristie-Marie Mammoliti, Fernando Althabe, Christina Easter, Adam Devall, James Martin, Adeosun Love Funmi, Rahmatu Yusuf, Fatima Abubakar, Lolade Christiana Arigbede, JimKelly Mugambi, Polycarp Oyoo, Masumbuko Sambusa, Akwinata Banda, Fawzia Samuels, Sara Willemse, Sibongile Doris Khambule, Hilal Mukhtar Shu'aib, Aminu Ado Wakili, Jenipher Okore, Ard Mwampashi, Mandisa Singata-Madliki, Edna Arends, Elani Muller, Hadiza Galadanci, Zahida Qureshi, Fadhlun Alwy Al-Beity, G. Justus Hofmeyr, Sue Fawcus, Neil Moran, George Gwako, Alfred Osoti, Ioannis Gallos, Arri Coomarasamy\",\"doi\":\"10.1111/1471-0528.18293\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To compare the frequency and timing of postpartum haemorrhage (PPH) treatment initiation between hospitals implementing the MOTIVE treatment bundle (which consisted of uterine Massage, Oxytocic drugs, Tranexamic acid, IntraVenous fluids and Examination) and those following usual care.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Nested prospective observational study.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Setting</h3>\\n \\n <p>Hospitals in Nigeria, Kenya, Tanzania and South Africa participating in the E-MOTIVE trial.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Population or Sample</h3>\\n \\n <p>Healthcare workers treating PPH.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Between June and December 2022, we observed healthcare workers for 1–2 weeks in 39 E-MOTIVE and 39 usual care hospitals across Nigeria, Kenya, Tanzania, and South Africa managing vaginal birth and treating PPH. We descriptively compared the frequency and timing from PPH detection to treatment initiation of individual treatments and the MOTIVE bundle, between E-MOTIVE care and usual care.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Among 2578 observations in E-MOTIVE care hospitals, 295 (11%) PPHs were treated, and among 2834 observations in usual care hospitals, 219 (8%) PPHs were treated. In E-MOTIVE care hospitals, 97% (286/295) of women with PPH received the MOTIVE bundle, compared to 36% (79/219) in usual care. Median initiation times for the first component were similar (0 vs. 1 min), but E-MOTIVE care hospitals achieved faster initiation of all components (13 min, IQR 6–18) compared to usual care (18 min, IQR 10–25). In total, 79% (233/295) of women in E-MOTIVE care had all components initiated within 20 min, compared to 22% (48/219) in usual care.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Timely and comprehensive management of PPH using the MOTIVE bundle, particularly initiating all components within 15–20 min, was commonly observed in the E-MOTIVE care hospitals. Scaling up E-MOTIVE care should emphasise timely bundle initiation to strengthen PPH treatment and improve maternal health outcomes in low-and-middle-income countries.</p>\\n </section>\\n </div>\",\"PeriodicalId\":50729,\"journal\":{\"name\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"volume\":\"132 11\",\"pages\":\"1664-1672\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2025-08-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18293\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.18293\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bjog-An International Journal of Obstetrics and Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.18293","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的比较采用MOTIVE治疗方案（包括子宫按摩、催产药物、氨甲环酸、静脉输液和检查）的医院与常规护理的医院产后出血（PPH）开始治疗的频率和时间。设计嵌套前瞻性观察研究。尼日利亚、肯尼亚、坦桑尼亚和南非的医院参与了E-MOTIVE试验。人群或样本：治疗PPH的医护人员。方法在2022年6月至12月期间，我们在尼日利亚、肯尼亚、坦桑尼亚和南非的39家E-MOTIVE医院和39家普通护理医院观察了1-2周的医护人员，这些医院负责阴道分娩和治疗PPH。我们描述性地比较了从PPH检测到个体治疗开始的频率和时间，以及E-MOTIVE护理和常规护理之间的MOTIVE bundle。结果在E-MOTIVE护理医院2578例患者中，治疗了295例（11%），在普通护理医院2834例患者中，治疗了219例（8%）。在E-MOTIVE护理医院，97% (286/295)PPH妇女接受了MOTIVE捆绑治疗，而在常规护理中，这一比例为36%（79/219）。第一个成分的起始时间中位数相似（0 vs. 1分钟），但E-MOTIVE护理医院与常规护理（18分钟，IQR 10-25）相比，所有成分的起始时间更快（13分钟，IQR 6-18）。总的来说，79%（233/295）接受E-MOTIVE治疗的妇女在20分钟内启动了所有组件，而常规治疗的这一比例为22%（48/219）。结论在E-MOTIVE护理医院中，及时、全面地使用MOTIVE治疗方案，特别是在15-20分钟内启动所有组件，是PPH管理的普遍现象。扩大E-MOTIVE护理应强调及时启动捆绑治疗，以加强PPH治疗并改善低收入和中等收入国家的孕产妇健康结果。
When Is Postpartum Haemorrhage Treatment Initiated? A Nested Observational Study Within the E-MOTIVE Trial
Objective
To compare the frequency and timing of postpartum haemorrhage (PPH) treatment initiation between hospitals implementing the MOTIVE treatment bundle (which consisted of uterine Massage, Oxytocic drugs, Tranexamic acid, IntraVenous fluids and Examination) and those following usual care.
Design
Nested prospective observational study.
Setting
Hospitals in Nigeria, Kenya, Tanzania and South Africa participating in the E-MOTIVE trial.
Population or Sample
Healthcare workers treating PPH.
Methods
Between June and December 2022, we observed healthcare workers for 1–2 weeks in 39 E-MOTIVE and 39 usual care hospitals across Nigeria, Kenya, Tanzania, and South Africa managing vaginal birth and treating PPH. We descriptively compared the frequency and timing from PPH detection to treatment initiation of individual treatments and the MOTIVE bundle, between E-MOTIVE care and usual care.
Results
Among 2578 observations in E-MOTIVE care hospitals, 295 (11%) PPHs were treated, and among 2834 observations in usual care hospitals, 219 (8%) PPHs were treated. In E-MOTIVE care hospitals, 97% (286/295) of women with PPH received the MOTIVE bundle, compared to 36% (79/219) in usual care. Median initiation times for the first component were similar (0 vs. 1 min), but E-MOTIVE care hospitals achieved faster initiation of all components (13 min, IQR 6–18) compared to usual care (18 min, IQR 10–25). In total, 79% (233/295) of women in E-MOTIVE care had all components initiated within 20 min, compared to 22% (48/219) in usual care.
Conclusions
Timely and comprehensive management of PPH using the MOTIVE bundle, particularly initiating all components within 15–20 min, was commonly observed in the E-MOTIVE care hospitals. Scaling up E-MOTIVE care should emphasise timely bundle initiation to strengthen PPH treatment and improve maternal health outcomes in low-and-middle-income countries.
期刊介绍：
BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
