New Guidelines Set a Bold Course to Reduce Postpartum Hemorrhage Deaths
On October 5, 2025, leading reproductive health organizations issued a landmark set of guidelines aimed at dramatically reducing deaths from postpartum hemorrhage (PPH). The World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) collaborated to publish a comprehensive package of recommendations designed to transform prevention, diagnosis, and treatment of PPH across health systems with varying levels of resources.
The advisory document is anchored in findings from The Lancet’s October 2025 study—the largest analysis to date on how clinical indicators of postpartum bleeding predict death or severe morbidity. The study challenges conventional thresholds and argues for earlier intervention when risk signs are present, potentially changing the pace of care in both high- and low-resource settings.
A New Diagnostic Threshold: Why 300 mL Might Trigger Action
Traditionally, PPH has been defined by blood loss reaching 500 mL. However, the Lancet study found that measured blood loss below this conventional threshold—when paired with abnormal hemodynamic signs such as rapid heart rate or low blood pressure—can accurately flag women at risk of death or life-threatening complications. The Lancet authors advocate that even blood loss around 300 mL or less should trigger urgent evaluation and treatment when clinical signs indicate instability. This approach emphasizes proactive management rather than waiting for “maximum” bleeding to declare an emergency.
The E-MOTIVE Bundle: Immediate Action in the Critical Window
In the guidelines, a key mechanism to reduce mortality is the rapid deployment of the E-MOTIVE bundle of actions once PPH is diagnosed. The bundle includes:
- Massage of the uterus to stimulate contractions
- Oxytocic drugs to promote uterine tone
- Tranexamic acid to reduce bleeding
- Intravenous fluids to support circulation
- Vaginal and genital tract examination to identify ongoing sources of bleeding
- Escalation of care if bleeding persists, including access to higher-level interventions
Rare cases of persistent bleeding may require surgical intervention or blood transfusion to stabilize the patient while additional treatment is arranged. The package is designed to act swiftly in the critical moments after birth, especially in settings where resources are tight.
Aligning Policy and Practice: 51 Recommendations Across Systems
The consolidated guidelines comprise 51 recommendations spanning prevention, diagnosis, treatment, supportive care, and health system strengthening. They are accompanied by an extensive suite of training and implementation resources, co-developed with partners such as the United Nations Population Fund (UNFPA). These tools support frontline health workers and policymakers in adopting new practices, from national guidelines to simulation-based emergency response training.
Global Roadmaps and Local Realities
The guidelines are a pivotal component of the Global Roadmap to Combat Postpartum Hemorrhage (2023–2030), launched to galvanize action across research, norms, implementation, and advocacy. While high-income countries have nearly eliminated PPH deaths, the burden remains disproportionately high in low- and lower-middle-income countries—particularly in sub-Saharan Africa and South Asia. By focusing on timely diagnosis and aggressive initial management, the guidelines aim to maximize impact where the burden is greatest and resources are most limited.
World PPH Day and the Path Forward
From 2025 onward, October 5 is commemorated as World PPH Day, signaling a global commitment that no woman should die from preventable postpartum hemorrhage. The new guidelines and accompanying resources are intended to inform national and sub-national policy, clinical guidelines, and programmatic plans, accelerating progress toward Sustainable Development Goal 3: Good Health and Well-Being. In 2023, about 45,000 of roughly 260,000 maternal deaths were due to PPH. The 2025 guidelines seek to close the remaining gaps and safeguard mothers’ health as they return home to their families.
What This Means for Patients, Clinicians, and Health Systems
For patients, the shift toward earlier recognition of risk signs means faster access to life-saving care. For clinicians, the emphasis on the E-MOTIVE bundle provides a clear, standardized protocol that can be taught and audited. For health systems, the resources and training materials offer a practical pathway to implement evidence-based practices at scale, even in resource-limited environments.
Looking Ahead
As countries integrate these recommendations into national guidelines and health plans, the hope is that maternal mortality from PPH will continue to decline—reducing inequities and helping more women survive and thrive after childbirth. The collaboration behind these guidelines reflects a shared commitment to turning research into action and saving lives when every minute counts.
