Preventing and Treating Life-threatening Perioperative Maternal Haemorrhage - Phase 2

Research Questions

Why do health systems in Africa fail to provide women at high risk of post-partum haemorrhage with evidence-based treatment? What is the provision of evidence-based care for post-partum haemorrhage across Africa? Can we co-produce a complex intervention which improves evidence-based care and survival for high-risk patients?

Phase 2

We will build on the findings of the Phase 1 studies in this phase. Initially we will use a rapid evaluation survey tool to assess the capacity of healthcare facilities to provide the care that is prescribed in the WHO guidelines. This will include all aspects of care, including infrastructure, staffing ratios, equipment and drug availability and skill sets. This will be conducted in all of the APORG hospitals (approximately 900 hospitals).

We will then design an intervention that will be based on current evidence and will build on the knowledge gained through the Ugandan studies and the survey capacity assessment. This will be co-designed with patients and staff, suitable for use in a wide range of African hospitals to promote the basic (non-surgical) elements of evidence-based treatment of life-threatening post-partum haemorrhage. We will convene co-production workshops at associated hospitals in each partner country to explore acceptability and feasibility issues and plan how the intervention will fit into local contexts.

We will then conduct a feasibility study of this intervention in ten hospitals in Africa, with the aim of assessing whether the intervention appropriately identified mothers that were at risk of bleeding or had suffered bleeding, and whether the designed protocols could be adhered to.


  • This phase includes the Rapid Evaluation Survey Tool (REST), risk stratification strategy and then the design of the complex intervention and feasibility study (in ten hospitals). 
  • The REST manuscript has been submitted for publication to Anaesthesia and Analgesia Global Health.
  • We are now focusing on producing a perioperative care package to improve clinical outcomes in patients with haemorrhage during and after caesarian sections.
  • This will be ‘The Rule of THUMB trial’, which we hope to conduct in South Africa, Uganda Ethiopia and Tanzania.
To learn more about Phase 3