Global Guidelines Target a Critical Shift in Postpartum Hemorrhage Care
On October 5, 2025, leading reproductive health organizations introduced a comprehensive set of guidelines aimed at transforming the prevention, diagnosis, and treatment of postpartum hemorrhage (PPH). Issued by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM), the guidelines reflect an urgent push to save lives where PPH remains a leading cause of maternal mortality, particularly in low-income and lower-middle-income countries.
New Diagnostic Thresholds and Early Intervention
The guidelines are anchored in the latest evidence from The Lancet study published October 4, 2025, which analyzed whether clinical signs and measured blood loss can better predict progression to death or severe morbidity. A key finding is that using a more proactive approach—recognizing abnormal hemodynamic signs even when measured blood loss is below the conventional 500 mL threshold—can identify women at high risk earlier. Some experts suggest a trigger as low as 300 mL, especially when accompanied by adverse signs, to initiate prompt treatment.
As a result, the guidelines promote objective, standardized criteria to detect PPH earlier. This shift is designed to overcome delays in recognizing hemorrhage, a problem that persists in settings with limited resources and overwhelmed health systems.
The E-MOTIVE Bundle: A Ready-to-Act Response
Central to the new guidance is the immediate deployment of the E-MOTIVE bundle of actions as soon as PPH is diagnosed. The components include uterine massage, administration of oxytocic drugs to promote contractions, tranexamic acid to limit bleeding, rapid intravenous fluid resuscitation, thorough vaginal assessment, and escalation of care if bleeding continues. In scenarios where bleeding persists despite initial measures, the bundle supports timely life-saving procedures, such as surgical intervention or blood transfusion, to stabilize the patient while additional treatment is arranged.
Training, Resources, and Global Implementation
The guidelines come paired with a robust set of training and implementation resources developed with partners like the United Nations Population Fund (UNFPA). These materials are designed for frontline health workers and national authorities, including simulation-based training to strengthen emergency response and practical guides for integrating new practices into policy and clinical workflows. The aim is to maximize impact in high-burden, resource-constrained settings where improvements in PPH care can translate into dramatic reductions in mortality and morbidity.
Bridging Equity Gaps in Maternal Health
Although PPH-related deaths have fallen in high-income countries, they remain disproportionately high in sub-Saharan Africa and South Asia. The Lancet study, which underpins the new guidance, emphasizes that improved recognition and rapid treatment of PPH hold the promise of closing these inequities. By providing clear diagnostic criteria and a ready-to-use treatment bundle, the guidelines seek to empower health systems with actionable steps that are feasible even where resources are scarce.
A Global Roadmap and a New World PPH Day
These consolidated guidelines form a crucial milestone in the Global Roadmap to Combat Postpartum Hemorrhage (2023–2030). The roadmap, launched in 2023, aligns research, norms, implementation, and advocacy to accelerate progress toward Sustainable Development Goal 3, which seeks to improve maternal health. Beginning this year, October 5 will be observed as World PPH Day, underscoring the commitment that no woman should die from a preventable hemorrhage and reinforcing momentum for policy adoption and health system strengthening.
What This Means for Policy and Practice
For policymakers, clinical leaders, and healthcare workers, the 51 recommendations cover prevention, diagnosis, treatment, supportive care, and health system interventions. The emphasis is on timely, evidence-based actions, standardized protocols, and the scalable deployment of the E-MOTIVE bundle. As nations translate these guidelines into national and sub-national policies, the goal is to save more lives, shorten hospital stays, and enable more women to recover safely at home with their families.
