New Guidelines Aim to Stop Postpartum Hemorrhage Deaths with Early Action
On October 5, 2025, leading reproductive health organizations unveiled a comprehensive set of guidelines designed to transform how postpartum hemorrhage (PPH) is prevented, diagnosed, and treated. The World Health Organization (WHO), the International Federation of Gynecology and Obstetrics, and the International Confederation of Midwives published the recommendations, which emphasize objective diagnostic criteria and a rapid, standardized response when PPH is suspected. These guidelines come on the heels of the largest study to date, published in The Lancet on October 4, 2025.
Turning the Corner on Diagnostic Thresholds
The Lancet study evaluated how well clinical indicators predict death or severe morbidity from PPH. The findings call for a paradigm shift: while a conventional threshold of 500 mL blood loss has long guided treatment, the researchers argue that a lower trigger—around 300 mL or less—should prompt immediate action when accompanied by abnormal hemodynamic signs. This approach aims to identify at‑risk women earlier, especially in settings where delays Lethal to lives already stretched thin by resource constraints.
The Global Imperative: Equity in Maternal Health
Although maternal deaths from PPH have declined in high‑income countries, they remain unacceptably high in many low‑ and lower‑middle‑income regions, notably in sub‑Saharan Africa and South Asia. The new guidelines are a response to this disparity, offering practical tools to improve outcomes where the burden is greatest. The advisory document also aligns with global efforts to meet Sustainable Development Goal 3: good health and well‑being, by accelerating progress toward safer childbirth for all women.
The 51 Recommendations: Prevention, Diagnosis, Treatment, and System Strengthening
The consolidated guidance contains 51 recommendations spanning prevention, early detection, treatment, supportive care, and health system interventions. A central pillar is the deployment of the E‑MOTIVE bundle immediately after PPH is diagnosed. The bundle includes:
- Massage of the uterus
- Use of oxytocic drugs to stimulate contractions
- Administration of tranexamic acid to reduce bleeding
- Intravenous fluids to maintain circulation
- Genital tract examination to identify ongoing sources of bleeding
- Escalation of care if bleeding persists
In cases where bleeding continues despite initial measures, the guidelines endorse swift surgical interventions or blood transfusion to stabilize the patient while additional therapy is arranged. The emphasis is on rapid, decisive action that stops the bleeding before it leads to life‑threatening complications.
Implementation Tools and Training for Frontline Workers
Recognizing that guidelines alone cannot save lives, the WHO and partners released a suite of implementation resources. These include frontline training materials, national guidelines to adapt practices locally, and simulation‑based programs to strengthen emergency response. The tools were developed with significant input from partners such as the United Nations Population Fund, ensuring relevance across diverse health systems.
A Global Roadmap and World PPH Day
The guidelines represent a crucial step within the Global Roadmap to Combat Postpartum Hemorrhage (2023–2030), a coordinated effort to unify research, policy, and practice. October 5 will henceforth be observed as World PPH Day, a reminder that preventable deaths from postpartum bleeding should no longer be tolerated. As Jeremy Farrar noted, these measures aim to maximize impact where the burden is highest, empowering communities and health workers to protect mothers and families.
Looking Ahead
With more than 260,000 maternal deaths recorded in 2023 worldwide and around 45,000 attributed to PPH, the new guidelines seek to close the remaining gap through timely diagnosis, prompt treatment, and strengthened health systems. The combined strategy of lowering diagnostic thresholds, standardized response bundles, and robust training could accelerate progress toward safer childbirth for all women.
