New Guidelines Aim to End Deaths from Postpartum Haemorrhage
Global health agencies released landmark guidelines today to transform how postpartum haemorrhage (PPH) is prevented, diagnosed, and treated. The collaboration among the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) emphasizes earlier detection and swifter intervention, aiming to save tens of thousands of lives each year and reduce the long-term harm that PPH can inflict on women.
Why These Guidelines Matter
PPH—excessive bleeding after childbirth—remains a leading cause of maternal mortality worldwide, affecting millions and causing nearly 45,000 deaths annually. Even when not fatal, PPH can lead to serious complications such as organ injury, hysterectomy, anxiety, and trauma. The new guidelines are designed to address the speed with which PPH can escalate and the realities of health systems with limited resources.
Dr Jeremy Farrar, Assistant Director-General for Health Promotion and Disease Prevention and Care, underscored the urgency: “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.”
New Diagnostic Criteria for Faster Action
The guidelines, published by WHO, FIGO and ICM, introduce objective criteria to trigger rapid response. They are grounded in the largest study on the topic to date, with findings published in The Lancet. While traditional thresholds used 500 mL as the benchmark for PPH, clinicians are now advised to act at 300 mL of blood loss—or earlier if abnormal vital signs are present. The aim is to close the gap between onset and treatment, particularly in settings where resources are stretched.
To detect PPH early, health workers should monitor women closely after birth and use calibrated drapes to quantify blood loss accurately. This enables immediate action when the criteria are met, reducing the window in which complications can develop.
The MOTIVE Bundle: Immediate Response to PPH
On diagnosing PPH, the guidelines call for the rapid deployment of the MOTIVE bundle of actions:
– Massage of the uterus
– Oxytocic drugs to promote 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 despite initial measures, the guidelines advise safe progression to surgical interventions or blood transfusion to stabilize the patient while additional treatment is arranged. The emphasis is on timely, evidence-based care that can be implemented across diverse health settings.
Prevention and System Readiness
Prevention remains central to reducing PPH deaths. The guidelines advocate strong antenatal and postnatal care, with a focus on correcting anaemia—common in low- and lower-middle-income countries—and reducing risk factors for severe bleeding. Recommendations include daily oral iron and folate during pregnancy and intravenous iron when rapid correction is needed. If oral therapy fails, intravenous iron provides a critical alternative.
The document discourages unsafe practices such as routine episiotomies and endorses preventive methods like perineal massage during late pregnancy to lower the risk of trauma and bleeding. For the third stage of labour, the guidelines prefer a high-quality uterotonic—ideally oxytocin or heat-stable carbetocin. When cold-chain or intravenous options are unreliable, misoprostol is endorsed as a last resort.
Implementation, Training, and Global Impact
To translate guidelines into real-world impact, a suite of training and implementation tools accompanies the release. Developed with UNFPA and partners, these resources include frontline modules, national-level guides, and simulation-based training to strengthen emergency response. The launch aligns with the Global Roadmap to combat postpartum haemorrhage from 2023 to 2030 and marks a crucial step toward ending preventable deaths.
“Midwives know first-hand how quickly PPH can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent OBE, ICM’s Chief Midwife. “These guidelines are a game-changer, but action must come from governments, health systems, donors, and partners who are willing to invest in midwives and maternal care.”
Official Context and Support
The guidelines, which include 51 recommendations, synthesize existing and new evidence to reduce PPH incidence and improve outcomes. A related Lancet study evaluating indicators of serious postpartum bleeding across 23 countries adds further insight into diagnostic accuracy and prognostic markers. Funding for the guideline work was provided by the Gates Foundation.
