Outcome of postpartum hemorrhage in patients managed with the Modified Emotive bundle at a tertiary care center

Syeda Amna Asim Kazmi; Bushra Iftikhar; Nasreen Hassan Niazi; Ayesha Mushtaq; Asma Sattar; Summiya Manzoor

doi:10.71104/jsogp.v16i3.1101

Syeda Amna Asim Kazmi Post graduate resident (FCPS=II), of Gynae & Obs, CMH Malir, Karachi
Bushra Iftikhar Associate Professor of Gynae & Obs, CMH Malir, Karachi
Nasreen Hassan Niazi Associate Professor of Gynae & Obs, CMH Malir, Karachi
Ayesha Mushtaq Senior Registrar of Gynae and OBS, Sir Syed Hospital, Karachi
Asma Sattar Senior Registrar of Gynae and OBS, Sir Syed Girls College/Hospital Karachi
Summiya Manzoor Consultant Gynecologist, Usman Memorial Hospital Karachi

DOI: https://doi.org/10.71104/jsogp.v16i3.1101

Keywords: Postpartum hemorrhage, Modified Emotive bundle

Abstract

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality, especially in low- and middle-income countries. The Modified Emotive bundle offers a structured management approach, but local evidence from Pakistan is
limited.
Methods: This prospective cohort study was conducted at the Department of Gynaecology and Obstetrics, CMH Malir, Karachi, from April to September 2025. A total of 68 women aged 18–55 years, with gestational age ≥34 weeks and diagnosed with PPH, were included using consecutive sampling. All were managed with the Modified Emotive bundle, and blood loss was measured using calibrated drapes. The
outcomes included incidence of severe PPH, need for blood transfusion, surgical intervention, and intensive care unit (ICU) admission.
Results: The mean maternal age was 35.36 ± 11.10 years, gestational age 37.38 ± 1.93
weeks, and BMI 27.26 ± 5.81. Severe PPH occurred in 5 patients (7.4%). Blood transfusion was required in 9 patients (13.2%), surgical intervention in 3 (4.4%), and ICU admission in 2(2.9%). No significant associations were found between outcomes and maternal or obstetric characteristics.
Conclusion: The Modified Emotive bundle was effective in controlling PPH with low rates of transfusion, surgery, and ICU admission. Larger multicenter studies are needed to confirm these findings and support their adoption in national protocols.