AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 43 AFJOG ABSTRACTS African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | Abstracts Conclusion: Globally, CS training occurs mainly through apprenticeship, and many participants rated their training as inadequate. Well-proven educational strategies, such as feedback and structured assessment of competence, are underutilised, especially in LMIC. Doctors in LMIC perform more CS annually. Adequate feedback and assessment of competence prior to operating independently could possibly improve outcomes. ABSTRACTTITLE: 171: Randonized trial of early detection and treatment of postpartum haemorrhage: The emotive trail AUTHORS: neil.moran@kznhealth.gov.za Neil Moran 1 , Ioannis Gallos 2 , Hadiza Galadanci 3 , Fadhlun Alwy Al-beity 4 , Zahida Qureshi 5 , Sibongile Mandondo 6 , Susan Fawcus 7 , Mandisa Singata-Madliki 8 , Edna Arends 9 , Arri Coomarasamy 10 , Justus Hofmeyr 11 1 KZN Department of Health and Dept of Obstetrics and Gynaecology, University of KwaZulu-Natal 2 Department of Sexual and Reproductive Health and Research, World Health Organisiation 3 African Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria 4 Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania 5 Department of Obstetrics and Gynecology, University of Nairobi, Kenya 6 Eastern Cape Department of Health 7 Department of Obstetrics and Gynaecology, University of Cape Town 8 Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London 9 Retired: Western Cape Department of Health 10 College of Medical and Dental Sciences, University of Birmingham, UK 11 Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London Introduction: Postpartum haemorrhage (PPH) is the most common cause of maternal death worldwide. The objective of this trial was to evaluate the effect of implementation of the EMOTIVE intervention (blood collection drape and WHO treatment bundle) compared with usual care on PPH-related outcomes Methods: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for PPH in patients having vaginal delivery. The intervention included a calibrated blood-collection drape for objective measurement of post-partum blood loss to facilitate early detection of PPH and a standardized bundle (MOTIVE) of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe PPH (blood loss ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. Key secondary implementation outcomes were the detection of PPH and adherence to the treatment bundle. Results: Eighty hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32 to 0.50; P<0.001). PPH was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41 to 1.76), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI, 3.88 to 6.28). Conclusion: Objective measurement of blood loss and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe PPH, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery. There is a need to scale up the intervention at global and country level beyond the research sites ABSTRACTTITLE: 179: Test performance of hrHPV DNA and mRNA tests versus cytology among HIV-positive and negative South African women AUTHORS: Mrs Cathy Visser visser.cathy@gmail.com Greta Dreyer 1 , Cathy Visser 1 , Gerrit J Dreyer 2 , Leon C Snyman 1 , Frederick H van der Merwe 2 , Matthys H Botha 2 , Karin Richter 1 1 University of Pretoria 2 Stellenbosch University Introduction: There is an urgent need for local data on infection, disease prevalence, and screening test performance, among both HIV-positive (HPW) and HIV-negative women (HNW), to inform screening test selection. Methods: Women, aged 25-65 years, were enrolled to this cross-sectional multicentre study. Cervical specimens and biopsies (91.7% of screen-positive, 42.7% screen- negative participants) were collected. Unavailable histology was established by multiple imputation to adjust for verification bias. Cytology and different HPV tests were performed on overlapping subgroups: HPV DNA tests were Onclarity, Hybrid Capture 2 (HC2), Roche cobas and GeneXpert. HPV mRNA tests included Aptima and PreTect Proofer-8 (containing HPV16,18,45,31,33,52,58,35). Test performances were calculated against histology-confirmed cervical intraepithelial neoplasia grade 3 or worse (CIN3+) as gold-standard. Results: Enrolled were 1104 women, mean age 41.3 years, of which 58.7% were HNW. The sensitivity/ specificity/PPV/NPV of the different tests to detect CIN3+ in HNW were: cytology at cut- off of atypical squamous cells of undetermined significance (ASCUS+) 59.1%/87.8%/35.5%/95.0%; Onclarity 63.8%/82.3%/38.1%/94.7%; HC2 59.2%/83.8%/27.9%/95.1%; Roche cobas