RCT

E-MOTIVE

Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage

NEJM, 2023 · International cluster-randomized implementation trial

Clinical question

Does objective early PPH detection plus a bundled first-response treatment strategy reduce severe bleeding outcomes after vaginal birth?

Population: Women giving birth vaginally in participating hospitals
Intervention: Calibrated blood-collection drape plus bundled first-response PPH treatment and implementation strategy
Comparator: Usual PPH detection and treatment
Primary outcome: Composite of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding
Result: Early objective detection combined with bundled treatment reduced the composite severe PPH/laparotomy/death outcome compared with usual care.

What the trial found

A systems approach coupling objective blood-loss detection with prompt bundled treatment improved important PPH outcomes.

Current guideline position

The WHO/FIGO/ICM 2025 PPH guidance incorporates an early recognition and MOTIVE-style first-response bundle.

Clinical interpretation

Supports rapid objective recognition and simultaneous first-response therapy rather than waiting for profound blood loss or sequential treatment failure.

Clinical Context & Relevant Topics (1)

Disease Reference

Obstetric Critical Care

Maternal physiology, preeclampsia/eclampsia, HELLP vs AFLP, postpartum hemorrhage (MTP/TXA), peripartum cardiomyopathy, and arrest.

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