New Global Health Recommendations Aim to Eradicate Deaths from Postpartum Haemorrhage

Urgent Action Needed: New guidelines Issued to Combat Postpartum Hemorrhage

October 6, 2025

Global health organizations have released updated guidelines today, signaling a major shift in the prevention, diagnosis, and treatment of postpartum hemorrhage (PPH). These recommendations emphasize the necessity for quicker detection and intervention, potentially saving tens of thousands of lives annually. Pph is a critical health issue affecting millions of women globally.

What is Postpartum Hemorrhage?

Postpartum hemorrhage, defined as excessive bleeding following childbirth, currently impacts millions of women each year. sadly, it contributes to nearly 45,000 maternal deaths worldwide, establishing it as a leading cause of maternal mortality. Even in cases where it is not fatal, PPH can lead to lasting physical and psychological consequences, including serious organ damage, hysterectomies, anxiety, and trauma.

“Postpartum hemorrhage represents the most perilous complication during childbirth because of its rapid escalation.While not always predictable, fatalities are preventable with appropriate medical care,” stated Dr. Jeremy Farrar, Assistant Director-General for Health Promotion and Disease Prevention and Care. “These guidelines are strategically designed to maximize impact in regions with the greatest burden and most limited resources, ensuring more women safely return home to their families.”

New Diagnostic criteria for Faster Response

The World Health association (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) jointly published these groundbreaking guidelines. They introduce revised, objective diagnostic criteria for PPH, based on the most extensive study conducted to date on the subject. Previously, PPH was typically diagnosed as blood loss of 500 mL or more.

Now, clinicians are advised to take action when blood loss reaches 300 mL, especially when accompanied by abnormal vital signs. Early diagnosis requires vigilant monitoring of women after birth and the utilization of calibrated drapes-tools that accurately measure blood loss-allowing for immediate intervention when thresholds are met.

The “MOTIVE” Bundle: A Rapid Response Protocol

The guidelines advocate for the immediate implementation of the “MOTIVE” bundle of actions upon PPH diagnosis:

Letter	Action
M	Uterine Massage
O	oxytocic drugs (to stimulate contractions)
T	Tranexamic Acid (TXA) to reduce bleeding
I	Intravenous Fluids
V	Vaginal and Genital Tract Examination
E	Escalation of Care (if bleeding persists)

In rare instances of continued bleeding, the guidelines recommend interventions like surgery or blood transfusions to stabilize the patient until further treatment is available.

“Women impacted by PPH require care that is swift, practical, effective, and contributes to eliminating PPH-related deaths,” emphasized Professor Anne Beatrice Kihara, President of FIGO. “These guidelines promote a proactive approach of preparedness, recognition, and response, ensuring that healthcare providers can deliver the correct care, at the right moment, in diverse settings.”

Preventative Measures and Risk Reduction

The guidelines stress the meaning of complete antenatal and postnatal care to mitigate critical risk factors, such as anemia, especially prevalent in low- and lower-middle income countries. Anemia heightens the risk of PPH and worsens outcomes if it occurs. Recommendations include daily oral iron and folate supplementation during pregnancy, and intravenous iron transfusions when rapid correction is needed.

The publication also discourages routine episiotomies while advocating for preventive measures like perineal massage during late pregnancy to minimize trauma and severe bleeding post-delivery.

During the third stage of labor, administration of a quality-assured uterotonic is recommended to support uterine contraction, with oxytocin or heat-stable carbetocin preferred. Misoprostol may be utilized as a last resort when intravenous options aren’t available and the cold chain is unreliable.

“Midwives are acutely aware of how rapidly postpartum hemorrhage can worsen and threaten lives,” stated Professor Jacqueline dunkley-Bent OBE,ICM’s Chief Midwife. “These guidelines are a turning point. However, ending preventable deaths from PPH demands more than just evidence and protocols.We urgently call upon governments, healthcare systems, donors, and partners to fully adopt these recommendations, invest in midwives and maternal care, and make postpartum hemorrhage a tragedy of the past.”

Understanding Postpartum Hemorrhage: A Long-Term Perspective

Postpartum hemorrhage has been a recognized obstetric challenge for centuries. While historical management often relied on manual techniques and limited pharmacological interventions,advancements in understanding the underlying physiological mechanisms and the development of medications like oxytocin and tranexamic acid have significantly improved outcomes. Ongoing research continues to refine diagnostic criteria and treatment protocols, moving towards personalized care based on individual risk factors.

Did you know? According to the CDC, approximately 1-5% of vaginal births and 5-10% of cesarean births result in postpartum hemorrhage.

Pro Tip: Early identification of risk factors during prenatal care, such as multiple pregnancies, previous PPH, and anemia, can allow for proactive management strategies and reduce the likelihood of severe bleeding after childbirth.

Are you concerned about PPH? What steps can healthcare systems take to improve accessibility to emergency obstetric care?

Frequently Asked questions about Postpartum Hemorrhage

• What is the primary cause of postpartum hemorrhage? The most common cause is uterine atony, where the uterus fails to contract adequately after delivery.
• How can PPH be prevented? Good antenatal care, management of anemia, and appropriate use of uterotonic drugs during labor are crucial preventative measures.
• What are the warning signs of postpartum hemorrhage? Excessive bleeding, dizziness, rapid heart rate, and low blood pressure are all potential warning signs.
• Is postpartum hemorrhage treatable? Yes,with prompt and appropriate medical intervention,most cases of postpartum hemorrhage can be effectively treated.
• How does the “MOTIVE” bundle help in managing PPH? The MOTIVE bundle provides a standardized and rapid response approach to address the key factors contributing to postpartum hemorrhage.
• What role do midwives play in preventing PPH? Midwives are essential in providing antenatal care,monitoring labor and delivery,and recognizing and responding to PPH.
• Where can I find more data about postpartum hemorrhage? Resources are available from the World health Organization and the American College of Obstetricians and Gynecologists.

Share this critically important information with your network and let us know your thoughts in the comments below!

What are the key differences between the updated WHO recommendations for PPH management and previous guidelines?

Understanding Postpartum haemorrhage (PPH)

Postpartum haemorrhage (PPH), defined as excessive bleeding after childbirth, remains a leading cause of maternal mortality globally. It accounts for approximately 70,000 maternal deaths each year, disproportionately affecting women in low- and middle-income countries. Recent updates to global health recommendations, spearheaded by the World Health Organization (WHO) and other key organizations, aim to drastically reduce these preventable deaths. These new guidelines focus on proactive management, improved access to essential medicines, and strengthened healthcare systems. Key terms related to PPH include postnatal bleeding,maternal haemorrhage,and uterine atony.

The Updated WHO Recommendations: A Deep Dive

The WHO released revised guidelines in October 2023, building upon previous recommendations and incorporating the latest evidence-based practices. These recommendations are categorized into prevention, diagnosis, and management of PPH.

Here’s a breakdown of the key changes:

* Prophylactic Uterotonics: The most important update involves a shift towards routine use of uterotonic drugs – medications that help the uterus contract – during the third stage of labor (after the baby is born) for all births, regardless of risk factors. Previously,uterotonics were primarily reserved for women identified as high-risk. Oxytocin remains the first-line drug,but misoprostol is now more strongly recommended as an alternative where oxytocin isn’t available or feasible.

* Active Management of the Third Stage of Labour (AMTSL): AMTSL, encompassing prophylactic uterotonics, controlled cord traction, and uterine massage, is now universally recommended. This proactive approach substantially reduces the risk of PPH.

* Tranexamic Acid (TXA): TXA, an anti-fibrinolytic drug, is now recommended as a first-line treatment for women wiht severe PPH, alongside uterotonics and other interventions. Studies have demonstrated TXA’s effectiveness in reducing mortality in severe cases.

* uterine Massage: Consistent and effective uterine massage instantly after delivery and throughout the postpartum period is emphasized as a crucial, low-cost intervention.

* Early Identification & Rapid Response: Improved protocols for early detection of PPH – including regular monitoring of vital signs and blood loss – and rapid access to life-saving interventions are paramount. This includes establishing clear referral pathways and ensuring adequate blood supplies.

* Balloon Tamponade: The use of uterine balloon tamponade (UBT) is now more widely recommended as a temporary measure to control bleeding while awaiting definitive treatment.

Diagnosing Postpartum Haemorrhage: Recognizing the Signs

Early and accurate diagnosis is critical.Healthcare providers should be vigilant for the following signs:

* Visible Excessive Bleeding: Defined as blood loss exceeding 500ml after vaginal birth or 1000ml after cesarean section.

* Signs of Hypovolemic Shock: Including rapid heartbeat, low blood pressure, dizziness, pale skin, and altered mental status.

* Saturated Peripad within 15 Minutes: A swift assessment of blood loss.

* decreasing Haemoglobin Levels: Serial haemoglobin measurements can definitely help track blood loss.

Differential diagnosis is critically important to rule out other causes of bleeding, such as retained placental fragments or uterine rupture.

Management Strategies: A Tiered approach

Effective PPH management requires a tiered approach,escalating interventions based on the severity of bleeding.

1. First-Line Interventions: Uterotonics (oxytocin, misoprostol, methylergometrine), uterine massage, and controlled cord traction.
2. Second-Line Interventions: If bleeding persists, TXA should be administered.Bimanual compression of the uterus can also be effective.
3. Third-Line Interventions: These include uterine tamponade (balloon or packing), uterine artery ligation, and, as a last resort, hysterectomy. Blood transfusion is frequently enough necessary.

Benefits of Implementing the New Recommendations

The widespread adoption of these updated guidelines promises significant benefits:

* Reduced maternal Mortality: The primary goal – a ample decrease in deaths from PPH.

* **Improved Maternal Morbidity