November 06, 2023 3 min read

Introducing the MaternaWell Tray in the context of new findings showing how important measurement of blood loss is in triggering a bundle of interventions for PPH.

It’s rare in public health to find absolutely jaw-dropping results. Perhaps especially rare in the centuries old scourge of women dying in childbirth. But 2023 was different.

The E-MOTIVE trial was a massive multi-country cluster-randomized research study taking a fresh look at already identified interventions for postpartum hemorrhage, the leading cause of death for women in childbirth in many settings. And collectively, jaws did drop when the results showing a 60 percent reduction in severe bleeding and a 20% reduction in maternal death were announced.

200,000 women were part of the study, across80 health facilities in Kenya, Nigeria, South Africa, and Tanzania. The results were announced at the global IMNCH conference in South Africa and published in March 2023 in the New England Journal of Medicine. Maternova attended the conference, and here were our thoughts at the time.

The main innovation in the study wasthe bundling of interventions together, rather than sequentially¹. And equally as important, all of the interventions can be orchestrated by midwives. 

Here is the formula:

QBLM + uterine massage + Oxytocin/TXA + IV fluid + refer if needed

Central to the bundle was the quantitative measurement of blood loss (QBLM) as a way to get immediate real-time measurements of the amount of blood lost. The results showed that the use of calibrated collection drapes dramatically

  • increased the PPH detection rate, from 51% to 93%
  • Increased the use of the WHO recommended bundle of treatments, from 19% to 91%

In the E-MOTIVE study the plastic Brass-V drape was used (a plastic calibrated measuring drape)–at least 210,000 drapes were sent to the study sites.

The plastic underbuttocks drape was complemented by an immediate treatment bundle where indicated, including uterine massage, medicines to contract the womb and stop the bleeding, intravenous fluid administration, an examination and, when needed, escalation to advanced care. 

As critical as the QBLM step has proved to be to improve outcomes, the cost of shipping and having calibrated V-drapes on hand at all births is going to be prohibitive outside of a research setting. Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device. 

Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, the MaternaWellTray was conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.

Image of bleeding woman during childbirth laying on a MaternaWell Tray

The MaternaWell Tray is already in use in multiple facilities in South Africa and has very strong proponents. Research questions remain– Which method of QBLM do midwives prefer? Which method do laboring mothers prefer? 

For now, Dr. Hofmeyr is hearing strong positive feedback, with midwives giving unsolicited feedback like ...

“Those trays are the best thing that has ever happened to us.”

--- 

¹ A clinical care bundle is a set of discrete, evidence-based interventions, administered concurrently, or in rapid succession, to every eligible person, along with teamwork, communication, and cooperation. Once triggered, all bundle components must be delivered. 

 

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