Rethinking Postpartum Haemorrhage Care in Lower and Lower-Middle-Income Countries: A Comparative Review of E-MOTIVE Bundle and Single-Intervention Protocols
Alice Gaspari
31/08/2026
Postpartum haemorrhage is defined as a blood loss of more than 500 mL in a vaginal delivery. The E-MOTIVE bundle has been created to improve treatment in low- and middle-income countries (LMICs). This paper aims to explore the vulnerabilities of LMICs, particularly in terms of understaffing, supply chain fragility, and financial constraints, which raise questions about the bundle's long-term sustainability.
Methods: The paper was developed as a narrative review informed by realist principles, with PRISMA guidelines used to transparently report the literature search and the study-selection process. Papers from the last 8 years addressing PPH and/or E-MOTIVE protocol in LMIC settings were included. The search was conducted through PubMed, Google Scholar, Cochrane Library and Consensus, retrieving 101 records. The screening through Covidence platform firstly eliminated duplicates, then assessed eligibility through a title and abstract screening, finally a full-text screening was conducted, reducing the number to 31 studies, which underwent data extraction.
Conclusions: Findings indicated that the E-MOTIVE bundle appears to offer greater effectiveness in comparison with single-intervention protocols due to the objective diagnosis and prompt treatment administration. Policies should prioritise comprehensive and evidence-informed staff training, preparedness and increasing reliability on the uterotonics and medical equipment supply chain. Overall, the E-MOTIVE bundle has the potential to be a cost-effective and sustainable tool to treat PPH in LMICs, although further evidence, particularly on long-term implementation and cost-effectiveness across different settings, is needed to establish its broader applicability.