Weighing Up Causes of and Risk Factors for Postpartum Haemorrhage to Improve its Prevention

( Lancet . 2025;405:1440-1441. doi: 10.1016/ S0140-6736(25)00573-2.) Reducing maternal deaths from postpartum hemorrhage (PPH) requires the early identification of at-risk women, swift and accurate detection of bleeding after childbirth, and immediate use of standardized treatment protocols. The E-MOTIVE trial, conducted across four countries (Kenya, South Africa, Nigeria, and Tanzania) in 80 hospitals and involving over 210,000 patients, aimed to improve the early detection and initial management of PPH. A key innovation was using a calibrated blood collection drape to more accurately measure blood loss. Once 300 mL of blood loss was detected, a bundled first-response treatment was triggered. This included uterine massage, administration of oxytocin and tranexamic acid, IV fluids, and genital tract examination. The trial significantly reduced severe PPH events (defined as >1000 mL of blood loss), need for rescue laparotomy, or death from 4.3% in the standard care group to 1.6% in the intervention group, highlighting the effectiveness of structured early response.