Abstract
Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality globally. Effective management of PPH demands the implementation of E-MOTIVE bundle for early detection and management of PPH as recommended by the World Health Organization (WHO).
Aim: The scoping review aimed to map evidence on the implementation of the E-MOTIVE bundle for early detection and management of PPH emergencies globally.
Methods: The review adopted the Arksey and O’Malley methodological framework (2005). Six databases (CINAHL, MEDLINE, Scopus, PubMed, Web of Science and ProQuest) were searched for sources. The inclusion criteria consisted of full-text articles in English published between 2015 and 2025.
Results: A total of 14 articles were selected. The review revealed: 1. Types of PPH bundles, 2. Implementation strategies of E-MOTIVE bundle. 3. Barriers to effective implementation of the E-MOTIVE bundle.
Conclusion: A bundled care approach for the management of PPH following vaginal delivery has been shown to reduce adverse maternal outcomes because of PPH.
Contribution: The review addresses a critical gap in the implementation and suggests implementation strategies of the E-MOTIVE bundle, including objective blood loss estimation, scalable training, adoption to national policies and teamwork among the obstetric team.
Keywords: E-MOTIVE-bundle; postpartum haemorrhage; obstetric emergencies and complications; maternal healthcare; EmONC, maternal mortality.
Introduction
The World Health Organization (WHO 2012) initially released recommendations for the prevention and treatment of postpartum haemorrhage (PPH). Yet, more than a decade later, PPH continues to claim countless maternal lives, as many countries grapple with the persistent challenges to effectively implement strategies for early detection and management of PPH emergencies (Bohren et al. 2021). Postpartum haemorrhage is defined as a blood loss of ≥ 500 mLs in normal vaginal deliveries, and severe PPH is a blood loss of ≥ 1000 mLs after childbirth or caesarean section delivery in 24 h (Bohren et al. 2021, 2025; Forbes et al. 2023; Günaydın 2022). Postpartum haemorrhage remains one of the leading causes of preventable maternal mortality, contributing to approximately 27% of maternal deaths globally and between 30% and 50% of maternal deaths in sub-Saharan Africa supported by a Cochrane review conducted by Dwan et al. (2024), indicating that perinatal tears are a major contributor to PPH. In response to these persistent challenges, there is a growing body of literature that recognises the implementation of the WHO (2023b; 2025) strategies called E-MOTIVE bundle, designed to support the early detection and management of PPH following normal vaginal delivery (Forbes et al 2023; WHO 2023a). This bundle emphasises the use of a calibrated blood collection drape to enable timely detection, alongside evidence-based interventions delivered by skilled birth attendants within 15 min of identifying haemorrhage, to effectively control bleeding.
The causes of PPH include the 4 Ts uterine atony, birth canal trauma, retention of placental products and coagulation disorders (Petca et al. 2022; Yunas et al. 2025; Zenani et al. 2025). Bohren et al. (2025) highlight a particular concern: the most contributory factors to postpartum haemorrhage emergencies (PPH) are often preventable and avoidable causes. The initial factor includes late detection or missed identification of PPH post childbirth. The current status quo is that the obstetric team, comprising midwives and obstetricians, often uses ‘visual estimation’, observing visible pooling of blood under the woman, on the mattress and on soaked pads and linen as a method of estimating blood loss, which is often subjective, inaccurate and varies substantially between health providers (Bohren et al. 2021). The second factor is ineffective management of the PPH. The National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD) in South Africa has emphasised that management failure of PPH includes late detection and substandard care ‘too little too late’ as the cause of mismanagement PPH (Bohren et al. 2025; Singata-Madliki et al. 2023). Bohren et al. (2025) further suggest that among the factors contributing to PPH, the WHO E-MOTIVE bundle, also known as Care Bundles for PPH in other contexts is poorly implemented, especially in low-income and middle-income countries (LMICs) because of limited knowledge and skills, workforce shortages, inadequate medication and supply stockouts.
To address the contributing factors, the WHO (2023) has recommended the E-MOTIVE bundle, which is a new ‘Care Bundles’ aimed at improving the detection and first-response management of PPH as suggested by the WHO technical consultation of PPH bundle development (Durocher & Ononge 2025). The E-MOTIVE bundle is set as a tool to be used during emergencies as the first-line response in maternity hospitals, including six evidence-based interventions (Bohren et al. 2025; Fawcus 2020). The interventions include (1) E- stands for early detection of PPH using a calibrated blood collection drape. (2) M- is for massaging of the uterus. (3) O- means oxytocic drugs (10 IU in 200 ml of normal saline over 5 min – 10 min followed by 20 IU in 1 L over 4 h – 8 h). (4) T- is for tranexamic acid (TXA) (1000 mg in 100 mL – 200 mL over 10 min) to be administered. (5) IVs are intravenous fluids to be given. (6) E- stands for the examination, i.e. looking for the source of bleeding and identifying it, and escalation refers to advanced care, if bleeding persists despite first response (Forbes et al. 2023). Care bundles have been associated with improved patient outcomes when adherence is high. The implementation of care bundle for PPH may include behaviours such as the widely used airway, breathing, circulation ‘ABCs,’ which were designed in emergency care to remind health professionals of the sequence of resuscitation (Althabe et al. 2020; Musie et al. 2025; Shikuku et al. 2022). The bundle approach has been proposed as a suitable solution to suboptimal adherence to PPH guidelines.
Despite the promising outcomes of the E-MOTIVE bundle, several gaps remain in the literature regarding its implementation. Previous studies reported on the need to change clinical behaviour for effective implementation of the bundle (Bohren et al. 2021; Forbes et al. 2023). Previous studies omitted to report on suggested strategies that may enhance the implementation of the E-MOTIVE bundles across different countries. Therefore, the review aims to map and synthesise evidence on the implementation of the E-MOTIVE bundle for early detection and management of PPH emergencies globally.
Review question
The following is the review question: What are the available implementation strategies of the E-MOTIVE bundle for early detection and management of postpartum haemorrhage (PPH) emergencies globally?
Methods
Research design
This scoping review followed a five-step framework proposed by Arksey and O’Malley (2005) in Figure 1, and the reporting is done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist.
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FIGURE 1: The five-stage framework for scoping reviews. |
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Eligibility criteria
This scoping review collected and analysed peer-reviewed full-text empirical research articles written in English from 2015 to 2025 to ensure the latest articles pertaining to the implementation of the E-MOTIVE bundle globally are included. The scoping review followed the Population, concept and context (PCC) framework (Peters et al. 2021); inclusion and exclusion criteria were formatted (Table 1).
| TABLE 1: Inclusion and exclusion criteria based on population, concept and context. |
Search strategy, selection of sources and data extraction
The search strategy was developed in consultation with the ‘Information specialist redacted to maintain the integrity of the review process ‘Information specialist and the input of the research team. The authors searched for the relevant studies on the following six databases: CINAHL, MEDLINE, Scopus, PubMed, Web of Science and ProQuest, to retrieve the most relevant data. Descriptions such as title, abstract and full-text screening of the relevant and suitable studies on the topic of interest were used to conduct the search strategy. The following medical subject heading (MeSH) terms were used: e.g. (‘E-MOTIVE Bundle’ OR ‘EMOTIVE Bundle’ OR ‘bundle strategy’ OR ‘Care bundle’) And (‘Obstetricians’ OR ‘Midwives’ OR ‘Maternity’ OR ‘Obstetric’ OR ‘on-gyn’ OR ‘Gynaecologist’ OR ‘Midwife’) AND (‘Detection’ OR ‘Management’) AND (‘Postpartum haemorrhage’ OR ‘Haemorrhage’ OR ‘haemorrhage’ OR ‘Immediate Postpartum’ OR ‘Delayed postpartum’).
Following the literature search, all the identified studies were imported to the systematic review management system, namely Covidence (2023), which guided the screening process, title and abstract screening, review of full-text and data extraction. The eligibility for inclusion of articles was assessed independently by two reviewers (first author and second author). When disagreement or conflicts arise with the included or excluded articles, the two reviewers met and reached consensus for inclusion, and it was checked by the third author. The search results and decisions at each stage of extraction are summarised by the PRISMA ScR flowchart to illustrate the search process (refer Figure 2). Using a data extraction tool in the software, which was later extracted to an Excel sheet. The data were extracted by a researcher (refer Table 2). No formal quality assessment of the articles was conducted, as scoping reviews typically do not require an evaluation of methodological quality.
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FIGURE 2: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews flowchart illustrating the search process. |
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| TABLE 2: Characteristics of the included studies. |
Collating, summarising and reporting of results
In this step, the authors collated and summarised the results and drew conclusions from the review. Thematic analysis was performed by the first author according to Braun & Clarke (2006). The themes and subthemes on the implementation strategies of the E-MOTIVE bundle were identified.
Ethical considerations
Ethical clearance to conduct this study was obtained from the University of Pretoria Faculty of Health Sciences Research Ethics Committee on 12 June 2025. The ethical approval number is 65/2025.
Review findings
Selection of sources
A total of 611 records were retrieved from 2015 to 2025 (Figure 2). Following the removal of 348 duplicates, 263 studies remained for screening. The following 196 articles were excluded for not meeting the eligibility criteria based on abstract and title screening. Only n = 15 articles were eligible for full-text review, and one article was excluded as no E-MOTIVE bundle implementation was mentioned. After the full-text screening, only n = 14 studies were included for review.
Theme 1: Classification of postpartum haemorrhage care bundles
E-MOTIVE bundle: The studies included report on a variety of PPH care bundles implemented globally for the early detection and management of PPH. According to Atlhabe et al. (2020) and Tancred et al. (2023), the ‘care bundles’ were developed from the (WHO 2012, 2017) recommendation for PPH focusing the first response to PPH bundle (comprising uteronics, isotonic crystalloids, tranexamic acid and uterine massage for immediate and basic interventions for PPH) and the response to refractory PPH bundle (management when PPH does not respond to first-line measures including aortic or bimanual uterine compression), the non-pneumatic anti-shock garment (NASG) and intrauterine balloon tamponade (IBT) measures. The first WHO Recommendations and guidelines on the prevention and management of postpartum haemorrhage (PPH) were published in (WHO, 2012), followed by updated recommendations in 2017. The current approach builds on these recommendations, with the 2023 WHO E-MOTIVE bundle providing an updated, evidence-based approach for the early detection and timely management of postpartum haemorrhage. The review highlights six studies (n = 6, 43%), which report on the implementation of the new released care bundle by the WHO (2023) called the E-MOTIVE bundle, which is evidence-based approach for early detection and treatment of PPH including the following sub-Saharan Africa countries: Kenya, Nigeria, South Africa and Tanzania and globally (Akter et al. 2022, 2023; Bohren et al. 2025; Forbes et al. 2023; Singata-Madliki et al. 2023; Williams et al. 2024), including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. In South Africa, the E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies (ESMOE) algorithm.
National Partnership for Maternal Safety consensus bundle on obstetric haemorrhage: The review highlights three different types of care bundles of PPH utilised in the United States and other countries internationally. The first type of bundle is called the National Partnership for Maternal Safety (NPMS) consensus bundle on obstetric haemorrhage, implemented and reported in (n = 3, 21%) studies in countries such as the United States (De Tina et al. 2019; Main et al. 2015; Reale et al. 2019). The bundle was developed with the aim of reducing PPH mortality and morbidity. The NPMS is embedded in the following four domains: (i) readiness, (ii) recognition and prevention, (iii) response (iv) reporting and system learning.
Association of Women’s Health, Obstetric and Neonatal Nurses postpartum haemorrhage bundle: One (n = 1, 7%) study reported on the AWHONN PPH bundle, which refers to the set of evidence-based practices developed by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) for the prevention and management of PPH (Bingham et al. 2018). This bundle is developed based on similar four domains as the NPMS bundle.
Postpartum Haemorrhage Risk Assessment Tool: In the United States, one (n = 1, 7%) study reported on the PHRAT, which is utilised to identify women at risk of PPH and prompt immediate interventions for management. The tool also includes standardisation of protocols for PPH and employs quantitative blood loss (QBL) for all deliveries (Joseph et al. 2020).
Bundle of postpartum haemorrhage care for caesarean deliveries: One study (n = 1, 7%) conducted globally revealed a bundle approach for the management of PPH for caesarean deliveries (Pingray et al. 2024).
Theme 2: Implementation strategy of the E-MOTIVE bundle
Most of the studies propose several implementation strategies of the E-MOTIVE bundle to address the detection and management of PPH emergencies. These strategies will be discussed under the four R- Readiness, Recognition and Prevention, Response and Reporting and Systems Learning.
Recognition and prevention: Use of calibrated drapes: Most of the studies report the use of the calibrated drape as the first tool according to the E- for early identification of PPH within the first 15 min of recognising haemorrhage to initiate rapid response interventions. The drape includes measurements that allows for QBL objective assessment of blood loss after every vaginal birth (Akter et al. 2022; Joseph et al. 2020; Reale et al. 2019; Tancred et al. 2025) as described according to the National Partnership for Maternal Safety (NPMS) consensus bundle.The health provider uses a plastic calibrated blood collection drape placed under the woman’s buttocks to measure the amount of blood loss, addressing the delays in PPH detection and inaccurate measurement of blood loss (Akter et al. 2022, 2023; Bohren et al. 2025; Forbes et al. 2023; Singata-Madliki et al. 2023; Williams et al. 2024).
Readiness: Postpartum haemorrhage emergency trolley and/or kit to promote appropriate postpartum haemorrhage care provision: The readiness to manage the PPH emergency can be ensured through implementation strategies consisting of PPH trolleys or carry cases with necessary medications and supplies (except for oxytocin, which requires refrigeration). Furthermore, Tancred et al. (2025) further add that the trolleys should include medications as stipulated on the national standard protocols. A study done in South Africa adds that these carry cases is called the PPH box, which consist of all necessary equipment for the emergency and should be implemented within 15 min of diagnosing PPH (Singata-Madliki et al. 2023).
E-MOTIVE champions: Another strategy that has been suggested is the introduction of E-MOTIVE champions in every maternity units, which may assist to encourage the health professionals who may be resistantto initiate the E-MOTIVE bundle (Forbes et al. 2023). These champions will act as a response team as day-to-day leaders, ensuring the implementation of evidence-based interventions for management of PPH.
Response: E-MOTIVE training increasing competencies on postpartum haemorrhage management: The third identified implementation strategy includes training the obstetric team on the new E-MOTIVE bundle for management of PPH. Most of the studies (n = 8) suggested the training to be done on how to use the calibrated drape for blood collection (Akter et al. 2022, 2023; Bohren et al. 2025; Forbes et al. 2023; Singata-Madliki et al. 2023; Williams et al. 2024). The health workers working at the maternity units may undergo continuous professional development and attend onsite workshops on simulation-based such as drills on PPH, include flip-charts of the E-MOTIVE displayed in the delivery rooms (Williams et al. 2024). A study conducted in South Africa also suggests the inclusion of the E-MOTIVE bundle into the national policies for different countries (Singata-Madliki et al. 2023).
Reporting and systems learning: Audit and feedback: The audit and feedback strategy is identified under the Capability, Opportunity, Motivation and Behaviour (COM-B) and theoretical domains framework (TDF) (Akter et al. 2022). As supported by Main et al. (2015) which indicates the 13 domains for effective implementation of the PPH bundles. Under the last domain entitled Reporting & Systems Learning (Every unit), it is expected that each maternity unit conducts monthly departmental meetings where cases such as PPH are presented and critically discussed.
Theme 3: Barriers to implementation of the E-MOTIVE bundle
“Too little too late” (TLTL) interventions: The overarching barrier that was identified in the reviews is that the Too Little too late’ interventions is the barrier to effective implementation of the E-MOTIVE bundle. This refers to delayed, inadequate or incomplete responses of PPH that fail to prevent progression to severe morbidity or maternal death. The first one most cases the health providers delayed recognition of PPH by failing to quantify blood loss (Reale et al. 2019). The second one is failure to administer the first-line treatment of the E-MOTIVE bundle, which includes massaging the woman’s uterus and uterotonics not administered promptly or given in insufficient doses. The last delay is poor Referral and Escalation Systems, as seen in a study indicating clear gaps in the utilisation of tranexamic acid and uterine balloon tamponade not in line with the WHO guidelines for PPH management (Tancred et al. 2025).
Discussion
This review shows that the implementation of the WHO (2023b) E-MOTIVE bundle is associated with lower rates of adverse outcomes compared to usual care for PPH management. It is also associated with improved detection of PPH and a high rate of implementation of evidence-based interventions. The E-MOTIVE bundle consisted of a calibrated blood collection drape for early detection of PPH (E) and a bundle of first-response treatments (MOTIVE) comprising uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination and escalation (Bohren et al. 2025; Devall et al. 2025; Williams et al. 2024).
The review revealed the implementation in four African countries, an important consideration for future scale-up of the E-MOTIVE bundle is the quantity and quality is the need for adoption and implementation of the bundle in all countries globally (Durocher et al. 2025). On a global scale, maternal morbidity and mortality are predominantly associated with obstetric emergencies, including ectopic pregnancy, placental abruption, placenta previa, preeclampsia or pregnancy-induced hypertension, eclampsia, premature rupture of membranes (PROM), amniotic fluid embolism (AFE), uterine inversion or rupture, placenta accreta, umbilical cord prolapse and shoulder dystocia. Within this spectrum, PPH persists as the second leading cause of maternal mortality worldwide (WHO 2022; Zenani et al. 2025). These obstetric emergencies hinder progress towards the achievement of Sustainable Development Goal (SDG) 3.1, which aims to reduce the global maternal mortality ratio (MMR) to fewer than 70 deaths per 100 000 live births by 2030 (United Nations Assembly 2015).
The review calls for scaling up the implementation of the E-MOTIVE bundle for early detection and management of PPH. For effective implementation, interventions need to be adapted and scaled up using the Capability, Opportunity, Motivation, and Behaviour (COM-B) model in conjunction with the TDF (Akter et al. 2023).
Barriers to effective implementation have also been identified in countries such as Nigeria, Kenya and South Africa, noting several factors that may influence the implementation of the E-MOTIVE bundle, such as that the bundle favours a supine flat position for the drape to collect the blood loss (Forbes et al. 2023). A study reported nine cases of maternal near-miss because of PPH, corresponding to a maternal near-miss ratio (MNMR) of 8.7 per 1000 live births, with severe PPH contributing to 35% of maternal deaths (Mulongo, Kaura & Mash 2024). There is little belief that tranexamic acid can be used in the management of PPH as it was not used before. Therefore, midwives have no confidence in its application. Information on the use of the bundle is poor to the obstetric team; more training is expected so that the team can be oriented and skilled. This prevents the proper implementation of the bundle. The bundle comprises the various principles of PPH management that were used individually; some midwives are still dependent on the previous practice instead of following the whole bundle. Therefore, the statistics for PPH are still high because of barring factors to this E-MOTIVE bundle (Forbes et al. 2023). These comparisons emphasise the urgent need for standardised, evidence-based protocols such as E-MOTIVE to bridge critical gaps in implementation of the E-MOTIVE bundle for PPH management globally.
Strengths and limitations
A key strength of this scoping review is that it is the first to specifically examine implementation strategies for the E-MOTIVE bundle at a global level. However, a limitation is that the review was restricted to published literature, which may have excluded relevant grey literature and unpublished implementation experiences, potentially introducing bias.
Conclusion
This review mapped the existing evidence on the implementation of the E-MOTIVE bundle for the early detection and management of PPH emergencies globally. Countries may draw lessons from South Africa, where the E-MOTIVE bundle has been integrated into the ESMOE (Essential Steps in Managing Obstetric Emergencies) training for healthcare professionals and incorporated into national guidelines. For effective scale-up, this review recommends that obstetric teams undergo capacity building to enhance healthcare providers’ knowledge, skills and confidence through targeted training, simulation drills and continuous professional development programmes for postpartum management.
Acknowledgements
This article is based on research originally conducted as part of Sibonginhlanhla Mdanda’s masters’s thesis titled ‘Factors influencing the implementation of E-MOTIVE bundle for postpartum haemorrhage emergencies at a private hospital in Tshwane’, submitted to the Department of Nursing Sciences, University of Pretoria in 2026. The thesis is currently unpublished and not publicly available. The thesis was supervised by Maurine Rofhiwa Musie. The thesis was reworked, revised and adapted into a journal article for publication. The author confirms that the content has not been previously published or disseminated and complies with ethical standards for original publication.
The authors would like to acknowledge the Ubuntu nursing model, chaired by Professor Fhumulani Mulaudzi (Ph.D.), for providing a space of cross-cultural collaboration and funding a writing retreat for the writing of this manuscript.
Competing interests
The author reported that they received funding from the Research development programme, which may be affected by the research reported in the enclosed publication. The author has disclosed those interests fully and has implemented an approved plan for managing any potential conflicts arising from their involvement. The terms of these funding arrangements have been reviewed and approved by the affiliated university in accordance with its policy on objectivity in research.
CRediT authorship contribution
Maurine R. Musie: Conceptualisation, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing. Sibonginhlanhla P. Mdanda: Investigation, Writing – original draft. Fhumulani M. Mulaudzi: Funding acquisition, Supervision, Writing – review & editing. Sinethemba Nyandeni: Methodology, Writing – review & editing. Adolphina M. Thema: Methodology, Writing – review & editing. Felicia O. Meno: Methodology, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication and take responsibility for the integrity of its findings.
Funding information
This research received funding from the Research Development Programme (RDP grant no. #5662, University of Pretoria).
Data availability
The authors confirm that the data supporting the findings of this review article are available within the article and its references.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.
References
Akter, S., Forbes, G., Corona, M.V., Miller, S., Althabe, F., Coomarasamy, A. et al., 2023, ‘Perceptions and experiences of the prevention, detection, and management of postpartum haemorrhage: A qualitative evidence synthesis’, Cochrane Database of Systematic Reviews 11, CD013795. https://doi.org/10.1002/14651858.CD013795.pub2
Akter, S., Forbes, G., Miller, S., Galadanci, H., Qureshi, Z., Fawcus, S. et al., 2022, ‘Detection and management of postpartum haemorrhage: Qualitative evidence on healthcare providers’ knowledge and practices in Kenya, Nigeria, and South Africa’, Frontiers in Global Women’s Health 3, 1020163. https://doi.org/10.3389/fgwh.2022.1020163
Althabe, F., Therrien, M.N., Pingray, V., Hermida, J., Gülmezoglu, A.M., Armbruster, D. et al., 2020, ‘Postpartum hemorrhage care bundles to improve adherence to guidelines: A who technical consultation’, International Journal of Gynecology & Obstetrics 148(3), 290–299. https://doi.org/10.1002/ijgo.13028
Arksey, H. & O’malley, L., 2005, ‘Scoping studies: Towards a methodological framework’, International Journal of Social Research Methodology 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Bingham, D., Scheich, B. & Bateman, B.T., 2018, ‘Structure, process, and outcome data of Awhonn’s postpartum hemorrhage quality improvement project’, Journal of Obstetric, Gynecologic & Neonatal Nursing 47(5), 707–718. https://doi.org/10.1016/j.jogn.2018.05.002
Bohren, M.A., Lorencatto, F., Coomarasamy, A., Althabe, F., Devall, A.J., Evans, C. et al., 2021, ‘Formative research to design an implementation strategy for a postpartum hemorrhage initial response treatment bundle (e-motive): Study protocol’, Reproductive Health 18(1), 149. https://doi.org/10.1186/s12978-021-01162-3
Bohren, M.A., Miller, S., Mammoliti, K.-M., Galadanci, H., Fawcus, S., Moran, N. et al., 2025, ‘Early detection and a treatment bundle strategy for postpartum haemorrhage: A mixed-methods process evaluation’, Lancet Global Health 13(2), e329–e344. https://doi.org/10.1016/S2214-109X(24)00454-6
Braun, V. & Clarke, V., 2006, ‘Using thematic analysis in psychology’, Qualitative Research in Psychology 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
De Tina, A., Chau, A., Carusi, D.A., Robinson, J.N., Tsen, L.C. & Farber, M.K., 2019, ‘Identifying barriers to implementation of the national partnership for maternal safety obstetric hemorrhage bundle at a tertiary center: Utilization of the Delphi method’, Anesthesia and Analgesia 129(4), 1045–1050. https://doi.org/10.1213/ANE.0000000000003451
Devall, A.J., Nausheen, S., Muhammad, S., Soofi, S., Karmaliani, R., Lakhani, A. et al., 2025, ‘Early detection and bundled treatment of postpartum haemorrhage with the e-motive intervention: A prospective pre–post intervention study in Pakistan’, Lancet Obstetrics, Gynaecology, & Women’s Health 1(2), E114–E121. https://doi.org/10.1016/j.lanogw.2025.100010
Durocher, J. & Ononge, S., 2025, ‘Lessons for future implementation of the E-MOTIVE bundle’, The Lancet Global Health 13(2), e187–e188.
Dwan, K., Fox, T., Lutje, V., Lavender, T. & Mills, T.A., 2024, ‘Perineal techniques during the second stage of labour for reducing perineal trauma and postpartum complications’, Cochrane Database of Systematic Reviews 2024(10), CD016148. https://doi.org/10.1002/14651858.CD016148
Fawcus, S., 2020, ‘Maternal deaths from obstetric haemorrhage 2017–2019; are we overlooking deaths from postpartum haemorrhage after vaginal delivery?’, Obstetrics and Gynaecology Forum 30(4), 8–11.
Forbes, G., Akter, S., Miller, S., Galadanci, H., Qureshi, Z., Fawcus, S. et al., 2023, ‘Factors influencing postpartum haemorrhage detection and management and the implementation of a new postpartum haemorrhage care bundle (e-motive) in Kenya, Nigeria, and South Africa’, Implementation Science 18(1), 1. https://doi.org/10.1186/s13012-022-01253-0
Günaydın, B., 2022, ‘Management of postpartum haemorrhage’, Turkish Journal of Anaesthesiology and Reanimation 50(6), 396. https://doi.org/10.5152/TJAR.2022.21438
Joseph, N.T., Worrell, N.H., Collins, J., Schmidt, M., Sobers, G., Hutchins, K. et al., 2020, ‘Implementation of a postpartum hemorrhage safety bundle at an urban safety-net hospital’, American Journal of Perinatology Reports 10(03), e255–e261. https://doi.org/10.1055/s-0040-1714713
Main, E.K., Goffman, D., Scavone, B.M., Low, L.K., Bingham, D., Fontaine, P.L. et al., 2015, ‘National partnership for maternal safety consensus bundle on obstetric hemorrhage’, Journal of Midwifery & Women’s Health 60(4), 458–464. https://doi.org/10.1111/jmwh.12345
Mulongo, S.M., Kaura, D. & Mash, B., 2024, ‘A mixed methods study on continuity and care coordination based on the obstetric near miss approach’, Health SA Gesondheid 29, 2421. https://doi.org/10.4102/HSAG.v29i0.2421
Musie, M.R., Tagutanazvo, O.B., Sepeng, N.V., Mulaudzi, F.M. & Hlongwane, T., 2025, ‘A scoping review on continuing professional development programs for midwives: Optimising management of obstetric emergencies and complications’, BMC Medical Education 25(1), 296.
Petca, A., Plăcintă, A.-T., Rotar, I.C., Mehedinţu, C., Dănău, R.-A. & Petca, R.-C., 2022, ‘Postpartum hemorrhage management according to the underlying cause’, Obstetrica si Ginecologie 4(70), 421. https://doi.org/10.26416/ObsGin.70.4.2022.7490
Peters, M.D., Marnie, C., Tricco, A.C., Pollock, D., Munn, Z., Alexander, L. et al., 2021, ‘Updated methodological guidance for the conduct of scoping reviews’, JBI Evidence Implementation 19(1), 3–10. https://doi.org/10.1097/XEB.0000000000000277
Pingray, V., Williams, C.R., Al-Beity, F.M.A., Abalos, E., Arulkumaran, S., Blumenfeld, A. et al., 2024, ‘Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: A modified delphi-based international expert consensus’, BMJ Open 14(5), e079713. https://doi.org/10.1136/bmjopen-2023-079713
Reale, S.C., Leffert, L.R. & Farber, M.K., 2019, ‘Update on obstetric hemorrhage’, Current Anesthesiology Reports 9(1), 60–68. https://doi.org/10.1007/s40140-019-00311-6
Shikuku, D.N., Jebet, J., Nandikove, P., Tallam, E., Ogoti, E., Nyaga, L. et al., 2022, ‘Improving midwifery educators’ capacity to teach emergency obstetrics and newborn care in Kenya universities: A pre-post study’, BMC Medical Education 22(1), 749. https://doi.org/10.1186/s12909-022-03827-4
Singata-Madliki, M., Fawcus, S., Moran, N., Arends, E., Muller, E., Mandondo, S. et al., 2023, ‘Implementing e-motive for detection and treatment of postpartum haemorrhage in South Africa’, South African Medical Journal 113(12), 1526–1530. https://doi.org/10.7196/SAMJ.2023.v113i12.1164
Tancred, T., Weeks, A.D., Mubangizi, V., Nene Dei, E., Natukunda, S., Cobb, C. et al., 2025, ‘Assessment of structural and process readiness for postpartum haemorrhage care in Uganda and Ghana: A mixed methods study’, BJOG: An International Journal of Obstetrics and Gynaecology 132(4), 433–443. https://doi.org/10.1111/1471-0528.17953
United Nations, 2015, Transforming our world: The 2030 Agenda for Sustainable Development, United Nations, New York, NY.
Williams, E.V., Goranitis, I., Oppong, R., Perry, S.J., Devall, A.J., Martin, J.T. et al., 2024, ‘A cost-effectiveness analysis of early detection and bundled treatment of postpartum hemorrhage alongside the e-motive trial’, Nature Medicine 30(8), 2343–2348. https://doi.org/10.1038/s41591-024-03069-5
World Health Organization (WHO), 2012, WHO recommendations for the prevention and treatment of postpartum haemorrhage.
World Health Organization (WHO), 2017, Updated WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage: Highlights and key messages from the World Health Organization’s 2017 global recommendation (No. WHO/RHR/17.21), WHO, Geneva.
World Health Organization (WHO), 2022, Clinical management of obstetric and neonatal emergencies in Africa. Clinical management of obstetric and neonatal emergencies in Africa.
World Health Organization (WHO), 2023a, Improving maternal and newborn health and survival and reducing stillbirth: Progress report 2023, World Health Organization.
World Health Organization (WHO), 2023b, WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum haemorrhage, World Health Organization, Geneva.
World Health Organization (WHO), 2025, Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, World Health Organization, Geneva.
Yunas, I., Islam, M.A., Sindhu, K.N., Devall, A.J., Podesek, M., Alam, S.S. et al., 2025, ‘Causes of and risk factors for postpartum haemorrhage: A systematic review and meta-analysis’, Lancet 405, 1468–1480. https://doi.org/10.2139/ssrn.5132612
Zenani, N.E., Tulelo, P.M., Netshisaulu, K.G., Sepeng, N.V., Musie, M.R, Gundo, R. et al., 2025, ‘A scoping review on the contribution of interprofessional collaborative practices on preventing and managing post-partum haemorrhage in the health care system’, BMC Nursing 24(1), 455. https://doi.org/10.1186/s12912-025-02988-z
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