Reducing maternal mortality is a priority Sustainable Development Goal for Botswana. Postpartum haemorrhage is the most avoidable direct cause of maternal deaths. We have developed a low-cost Suction Tube Uterine Tamponade (STUT) method for treating postpartum haemorrhage and completed a proof-of-concept study (awarded the JJ Sciarra prize for best LMIC paper in the International Journal of Gynecology and Obstetrics in 2019).

Aims: To conduct a robust randomized trial of STUT in women at high risk of PPH

Expected outcomes: If proved effective, to partner with MOHW to implement the intervention in Botswana with the aim of reducing national maternal mortality

Approach: Participants will be consented patients giving birth at Princess Marina Hospital with high risk of PPH. We will allocate participants randomly to STUT or control groups. In the STUT group, after birth of the placenta, a suction tube will be inserted transvaginally into the uterine cavity.The control group will receive routine care.

The primary outcome will be measured blood loss after randomization >500ml. Secondary outcomes will be measured mean blood loss after randomization; clinical indicators of postpartum haemorrhage, acceptability to participants and adverse events.

Outcomes will be compared between the STUT and the control group.