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AbstractObjective To evaluate the effectiveness of the systematic use of a transparent plastic collector bag to measure postpartum blood loss after vaginal delivery in reducing the incidence of severe postpartum haemorrhage.Interventions Maternity units were randomly assigned to systematic use of a collector bag (intervention group) or to continue to visually assess postpartum blood loss after vaginal delivery (control group).Main outcome measures The primary outcome was the incidence of severe postpartum haemorrhage in vaginal deliveries, defined as a composite of one or more of blood transfusion, intravenous plasma expansion, arterial embolisation, surgical procedure, admission to an intensive care unit, treatment with recombinant factor VII, and death.Results Severe postpartum haemorrhage occurred in 189 of 11037 of vaginal deliveries (1.71%) in the intervention group compared with 295 of 14344 in the control group (2.06%). The difference was not statistically significant either in individual level analysis (adjusted odds ratio 0.82, 95% confidence interval 0.26 to 2.53) or in cluster level analysis (difference in weighted mean rate adjusted for baseline rate 0.16%, 95% confidence interval 0.69% to 1.02%). From reports in developed countries, about 1% of deliveries are associated with severe postpartum haemorrhage.3 4 5 6Decreasing the prevalence of severe postpartum haemorrhage remains a challenge.

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