A watershed moment in maternal health
Today, leading reproductive health agencies released landmark guidelines designed to dramatically reduce deaths from postpartum haemorrhage (PPH). The collaboration between the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) signals a bold shift toward earlier detection, faster intervention, and consistent care across diverse health settings. With PPH responsible for tens of thousands of deaths annually, the new recommendations target the most time-sensitive moments after childbirth.
PPH, defined as excessive bleeding after delivery, remains one of the leading causes of maternal mortality worldwide. Even when it does not end in death, it can cause lasting harm, including organ damage, the need for hysterectomies, and wide-ranging mental health consequences for mothers and families. The new guidelines aim to convert risk into rapid action, especially in overburdened health facilities where delays can be fatal.
“Postpartum haemorrhage is the most dangerous childbirth complication since it can escalate with such alarming speed. While it is not always predictable, deaths are preventable with the right care,” said Dr Jeremy Farrar, a key health leader involved in the initiative. “These guidelines are designed to maximize impact where the burden is highest and resources are most limited – helping ensure more women survive childbirth and can return home safely to their families.”
New criteria for rapid diagnosis
The guidelines, published by WHO, FIGO, and ICM, introduce objective diagnostic criteria for detecting PPH, grounded in the largest study on the topic to date. The study, published in The Lancet alongside the guidelines, confirms that many PPH cases occur without known risk factors, underscoring the need for vigilant monitoring and swift response.
Crucially, clinicians are advised to act when blood loss reaches 300 mL or more, or when abnormal vital signs are observed, even if the traditional threshold of 500 mL is not yet reached. To enable timely decisions, the guidelines recommend using calibrated blood-loss collection drapes to quantify bleeding accurately after birth and guide immediate action.
The MOTIVE bundle: rapid response after diagnosis
When PPH is diagnosed, the guidelines call for the immediate deployment of the MOTIVE bundle of actions:
- Massage of the uterus
- Oxytocic drugs to stimulate contractions
- Tranexamic acid (TXA) to reduce bleeding
- Intravenous fluids
- Vaginal and genital tract examination
- Escalation of care if bleeding persists
In rare cases where bleeding continues, surgical interventions or blood transfusions are recommended to stabilize the patient while additional treatment becomes available. The emphasis is on speed, simplicity, and adaptability to vary levels of healthcare resource availability.
Prevention: strengthening care before and after birth
Preventive measures begin with better antenatal and postnatal care. The guidelines stress addressing anaemia, a major risk factor for PPH in low- and lower-middle-income countries. Recommendations include daily oral iron and folate during pregnancy and intravenous iron when rapid correction is needed, including after PPH. The document also discourages routine episiotomies and promotes perineal massage in late pregnancy to reduce trauma and bleeding risk.
During the third stage of labour, a high-quality uterotonic—preferably oxytocin or heat-stable carbetocin—is advised. If intravenous options are unavailable and cold-chain storage is unreliable, misoprostol can be used as a last resort. The guidelines also include a stronger emphasis on training multidisciplinary teams, particularly midwives, and enhancing emergency response capacity in diverse settings.
Implementation and global impact
Accompanying the guidelines is a suite of training and implementation resources, developed with partners including UNFPA. These modules are designed for frontline health workers, national health systems, and simulation-based training to strengthen emergency response. The launch at the 2025 FIGO World Congress in Cape Town aligns with the Global roadmap to combat postpartum haemorrhage from 2023 to 2030.
Experts emphasize that translating evidence into action requires political will and sustained investment. As Professor Jacqueline Dunkley-Bent, OBE, ICM’s Chief Midwife, notes, governments and donors must adopt these recommendations quickly and commit to expanding midwifery-led care as a core strategy to end preventable PPH deaths.
Why these guidelines matter
With 51 recommendations spanning prevention, diagnosis, and treatment, the guidelines offer a comprehensive framework to reduce mortality and morbidity from PPH. They represent a practical, real-world approach intended to save tens of thousands of lives each year, particularly in settings where resources are stretched thin. The collaboration and the accompanying resources mark a turning point in the global effort to make postpartum haemorrhage a preventable tragedy of the past.
