Abstract Postpartum hemorrhage (PPH) remains a major public-health challenge and the foremost cause of preventable maternal death worldwide. Despite clear clinical evidence on effective interventions, many countries continue to struggle with timely recognition and coordinated management of PPH, highlighting persistent gaps between research and routine practice. The World Health Organization (WHO) E-MOTIVE bundle – centred on objective blood-loss measurement and rapid, team-based treatment – has demonstrated substantial reductions in severe PPH in recent multicountry evaluations, yet its translation into national policy and frontline implementation varies widely. To better understand these gaps, we conducted a systematic review and realist synthesis in accordance with PRISMA 2020 guidance, examining how E-MOTIVE and related care-bundle strategies have been adopted, adapted, and scaled across health systems. A total of 1263 records were screened, and 26 studies met the inclusion criteria, spanning randomized trials, cost-effectiveness analyses, qualitative evaluations, implementation studies, and global policy frameworks. Across settings, successful scale-up was consistently linked to readiness in five domains: reliable supply chains, trained and empowered clinical teams, availability of objective detection tools, functioning audit and data-feedback mechanisms, and alignment of financing and governance structures. Realist analysis showed that policy uptake was most likely when credible technical evidence intersected with national leadership, institutional legitimacy, and stable funding commitments. These findings indicate that scaling E-MOTIVE requires system-level reforms rather than isolated clinical improvements. Integrating the bundle into national health benefits, procurement platforms, and digital monitoring systems may offer a practical pathway toward reducing preventable maternal deaths and strengthening primary-care readiness by 2030.
Andonotopo et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: