Background
The WHO has defined a postpartum haemorrhage (PPH) ‘first-response’
treatment bundle based on evidence, current recommendations, and
international consensus 1. The bundle comprises the
four key elements of uterotonic drugs, tranexamic acid (TXA),
intravenous (IV) fluids, and uterine massage. This treatment bundle has
been further developed with the creation of the E-MOTIVE intervention to
improve the detection and first response management of PPH, which
consists of: (1) E arly PPH detection using a calibrated drape;
(2) M assage of uterus; (3) O xytocic drugs; (4)T XA; (5) IV fluids; and (6) E xamination of
the genital tract and escalation when necessary 2. The
E-MOTIVE intervention is currently being evaluated in Kenya, Nigeria,
Pakistan, South Africa, and Tanzania.
A key implementation approach that we explored for the use of the
E-MOTIVE bundle is the co-administration (infusion) of the oxytocin
(OXY) and TXA components with the IV fluids. This approach could
simplify administration, which may be particularly important in
resource-constrained settings with limited numbers of healthcare
practitioners to attend a PPH emergency. Following an extensive
literature review, no reports were identified providing evidence of the
compatibility of OXY and TXA when mixed for intravenous administration.
Therefore, the aim of this study was to conduct a preliminary
investigation of the compatibility of OXY and TXA injection products
when mixed for the purpose of co-administration by IV infusion as part
of the treatment bundle for PPH. We used products collected from
clinical sites supporting the E-MOTIVE implementation research project.
We previously reported on the quality of individual oxytocin and TXA
injection products, sampled from E-MOTIVE sites in Kenya, Nigeria, South
Africa and Tanzania3. The results indicated samples of
both products that did not meet pharmacopoeial standards of quality in
terms of drug content and/or related substances and impurities.