Postpartum hemorrhage (PPH), defined as excessive bleeding after childbirth, remains the world’s leading cause of maternal mortality, responsible for nearly 45,000 deaths each year. Affecting millions of women globally, it can lead to serious health consequences, including organ damage, hysterectomies, and psychological trauma, even when not fatal. Early detection and rapid treatment are critical, but delayed diagnosis and limited resources often make timely care difficult. New global recommendations now aim to prevent these deaths through faster intervention and improved clinical readiness.

The World Health Organization (WHO, Geneva, Switzerland; www.who.int), in association with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM), has released new evidence-based guidelines redefining how PPH is prevented, diagnosed, and managed. The recommendations draw from the largest study to date on postpartum bleeding, published in The Lancet, and introduce updated diagnostic criteria for earlier intervention. Clinicians are now advised to act when blood loss reaches 300 mL accompanied by abnormal vital signs, instead of waiting for the traditional 500 mL threshold.

The new guidelines call for the use of calibrated drapes, simple measurement tools that collect and quantify blood loss to enable rapid detection. Once PPH is diagnosed, health workers are urged to deploy the MOTIVE bundle, which includes uterine Massage, Oxytocic drugs, Tranexamic acid (TXA), Intravenous fluids, Vaginal and genital tract Examination, with escalation to surgery or transfusion if bleeding persists. These practical, standardized actions are designed to support effective responses in low-resource and high-stress healthcare settings.

The recommendations also highlight the importance of prevention through maternal health care. Addressing anemia before and during pregnancy is critical, with daily iron and folate supplements or intravenous iron therapy recommended when oral treatments fail. Preventive measures such as perineal massage and the use of uterotonic drugs like oxytocin or heat-stable carbetocin are advised during labor, with misoprostol reserved for use when other options are unavailable.

These consolidated guidelines represent a major milestone in the global effort to eliminate PPH-related deaths. They are supported by a set of training and implementation resources developed with partners such as UNFPA. These include simulation-based learning modules, national rollout frameworks, and materials for strengthening emergency obstetric response. Together, they form part of the Global Roadmap to Combat Postpartum Hemorrhage (2023–2030).

“Postpartum hemorrhage 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, Assistant Director-General for Health Promotion and Disease Prevention and Care. “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.”

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