Lancet Series Describes Drape Protocol That Reduced Severe Postpartum Bleeding in Large African Trial

A three-part series published in The Lancet on June 12 describes a protocol that uses a calibrated plastic drape to measure blood loss after childbirth and applies multiple treatments at once when hemorrhage is detected. The approach was tested in a trial across Nigeria, Kenya, Tanzania and South Africa that enrolled more than 200,000 women and produced a large reduction in severe bleeding, according to Adam Devall, a professor of maternal health at the University of Oxford.

Postpartum hemorrhage kills 43,000 women each year and affects 27 million women annually.

Dr. Olufemi Oladapo, a physician with the World Health Organization’s Special Programme on human reproduction, co-authored the series and recalled treating a woman in Nigeria who died of the condition after waiting six years to become pregnant. He said the memory continues to shape his work.

The series states that visual estimation of blood loss misses hemorrhages roughly half the time. The calibrated drape collects blood beneath the woman and displays volume on marked lines, allowing midwives and doctors to identify excessive bleeding quickly. Once detected, the protocol calls for uterine massage, medication and intravenous fluids delivered together rather than in sequence.

The mortality rate from postpartum hemorrhage can be more than 200 times lower in well-resourced countries such as the United States than in lower-resource settings such as Afghanistan, Vietnam or Nigeria. The drug oxytocin, used to control bleeding, requires refrigeration, which limits its availability in many facilities.

The series also recommends simulation-based team training modeled on pit-crew procedures.