December 2017, Technical consultation for the development of the WHO PPH Care Bundles, Boston, MA.
Postpartum hemorrhage remains a leading cause of maternal mortality; the UCSF Safe Motherhood Team is committed to developing research and interventions towards improved management for women's survival.
Alongside the non-pneumatic anti-shock garment, other interventions are required, however women often do not receive all the interventions that they need for the best outcomes (Miller 2016). Patient care bundles may provide an effective approach to improve adherence to recommended evidence-based practices.
In August 2017, the UCSF Safe Motherhood team led the steering group for the development of WHO's PPH Care Bundles alongside colleagues from the Instituto de Efectividad Clínica y Sanitaria (IECS), and Massachusetts General Hospital, with support from the Gates Foundation (Althabe 2019).
This project produced two bundles: the first-response bundle composed of uterotonics, IV fluids, uterine massage, and tranexamic acid as a first response to PPH due to uterine atony, and the refractory bundle composed of the NASG, Uterine Balloon Tamponade (UBT), and additional doses of tranexamic acid and IV fluids.
The UCSF team continues to participate in ongoing research to explore how to improve the management of women experiencing postpartum hemorrhage. Professor Miller was a principal investigator on the E-MOTIVE trial testing the efficacy of early diagnosis and rapid, evidence based management of PPH vs. standard PPH care.