Leading reproductive health organizations have issued groundbreaking guidelines aimed at significantly reducing deaths caused by postpartum haemorrhage (PPH). On March 15, 2024, the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) published these new recommendations, underscoring the critical need for earlier detection and prompt intervention in the management of PPH.
Postpartum haemorrhage, defined as excessive bleeding following childbirth, affects millions of women globally and results in nearly 45,000 deaths each year. It ranks as one of the primary causes of maternal mortality. Beyond the immediate risk of death, PPH can lead to severe long-term health complications, including major organ damage, hysterectomy, anxiety, and trauma.
Dr. Jeremy Farrar, Assistant Director-General for Health Promotion and Disease Prevention and Care at WHO, emphasized the urgency of the situation. “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,” he stated. The newly released guidelines aim to address the issue particularly in regions where healthcare resources are limited, ensuring that more women can return home safely to their families after childbirth.
New Diagnostic Criteria and Immediate Response Protocols
The guidelines provide new objective diagnostic criteria for identifying PPH, drawing from the largest study on the topic published concurrently in The Lancet. Traditionally, PPH has been diagnosed when blood loss exceeds 500 mL, but the updated recommendations suggest that clinicians should also intervene at 300 mL if any abnormal vital signs are observed.
Healthcare professionals are encouraged to closely monitor patients following delivery and utilize calibrated drapes—devices designed to accurately measure blood loss. This proactive approach aims to facilitate immediate action when diagnostic criteria are met.
Once PPH is diagnosed, the guidelines advocate for the immediate implementation of the MOTIVE bundle of actions. This includes a series of interventions designed to stabilize the woman’s condition. In rare instances where bleeding persists, surgical options or blood transfusions may be necessary until further treatment can be administered.
Professor Anne Beatrice Kihara, President of FIGO, underscored the importance of timely and effective care. “Women affected by PPH need care that is fast, feasible, effective and drives progress towards eliminating PPH-related deaths,” she said. The guidelines promote a strategy of readiness, recognition, and response to empower healthcare workers in diverse settings.
Addressing Underlying Factors and Enhancing Care
The guidelines also highlight the significance of comprehensive antenatal and postnatal care to mitigate critical risk factors associated with PPH, such as anaemia, which is prevalent in low- and lower-middle-income countries. Anaemia not only increases the risk of PPH but can also worsen outcomes if it occurs. Recommendations for managing anaemic mothers include daily oral iron and folate during pregnancy, along with intravenous iron transfusions when rapid correction is necessary, particularly after PPH.
To improve maternal outcomes, the guidelines discourage unsafe practices like routine episiotomies and advocate for preventive measures such as perineal massage during late pregnancy to minimize the risk of trauma and severe bleeding. During the third stage of labour, the administration of quality-assured uterotonics, preferably oxytocin or heat-stable carbetocin, is recommended to encourage uterine contraction. In situations where intravenous options are unavailable, misoprostol may be used as a last resort.
Professor Jacqueline Dunkley-Bent OBE, Chief Midwife at ICM, expressed optimism about the guidelines’ potential impact. “Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives. These guidelines are a game-changer,” she stated. However, she stressed that achieving a reduction in preventable deaths from PPH requires more than just protocols. “We call on governments, health systems, donors, and partners to step up, adopt these recommendations quickly, and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past.”
The guidelines come equipped with a range of training and implementation resources developed in collaboration with partners, including the United Nations Population Fund (UNFPA). These resources consist of practical modules for frontline health workers, national-level guides for integrating new practices, and simulation-based training aimed at enhancing emergency response capabilities.
Launched at the 2025 FIGO World Congress in Cape Town, South Africa, these consolidated guidelines represent a vital advancement in the global effort to combat postpartum haemorrhage between 2023 and 2030. With a focus on effective interventions and comprehensive care, they aim to ensure that more women survive childbirth and thrive in their postnatal lives.
