New PPH guidelines push earlier detection and treatment

Global health agencies issued landmark recommendations on October 5, 2025 to overhaul how postpartum haemorrhage is prevented, diagnosed, and treated, calling for earlier detection and faster intervention to save tens of thousands of lives each year.

Defined as excessive bleeding after childbirth, postpartum haemorrhage affects millions of women annually and causes nearly 45,000 deaths, with many survivors facing lifelong physical and mental health impacts including major organ damage, hysterectomies, anxiety, and trauma.

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

Published jointly by the World Health Organization, the International Federation of Gynecology and Obstetrics, and the International Confederation of Midwives, the guidelines introduce new objective diagnostic criteria based on the largest study to date also released in The Lancet.

Clinicians are now advised to act when blood loss reaches 300 mL and any abnormal vital signs have been observed, replacing reliance on the traditional 500 mL threshold alone to trigger response.

To enable rapid action, doctors and midwives are urged to closely monitor women after birth and use calibrated drapes that accurately quantify blood loss so teams can intervene immediately when criteria are met.

Once PPH is diagnosed, the guidelines recommend immediate deployment of the MOTIVE bundle—Massage of the uterus, Oxytocic drugs, Tranexamic acid, Intravenous fluids, Vaginal and genital tract examination, and Escalation of care if bleeding persists—in a single, coordinated response.

In rare cases where bleeding continues, effective interventions such as surgery or blood transfusion are advised to stabilize a woman’s condition until further treatment becomes available.

“Women affected by PPH need care that is fast, feasible, effective and drives progress towards eliminating PPH-related deaths,” said Professor Anne Beatrice Kihara, President of FIGO.

“These guidelines take a proactive approach of readiness, recognition and response. They are designed to ensure real-world impact – empowering health workers to deliver the right care, at the right time, and in a wide range of contexts.”

The recommendations also prioritize prevention through strong antenatal and postnatal care that addresses anaemia, which heightens PPH risk and worsens outcomes, including daily oral iron and folate during pregnancy and intravenous iron transfusions when rapid correction is needed or after PPH if oral therapy fails.

The publication discourages unsafe practices such as routine episiotomies and promotes preventive techniques like perineal massage in late pregnancy to reduce trauma and severe bleeding.

During the third stage of labour, a quality-assured uterotonic is recommended to support uterine contraction—preferably oxytocin or heat-stable carbetocin as an alternative—with misoprostol reserved as a last resort where intravenous options and cold-chain reliability are limited.

“Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent OBE, ICM’s Chief Midwife.

“These guidelines are a game-changer. But to end preventable deaths from PPH, we need more than evidence and protocols. We call on governments, health systems, donors, and partners to step up, adopt these recommendations, adopt them quickly, and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past.”

The consolidated guidelines are accompanied by training and implementation resources developed with partners including UNFPA, featuring practical modules for frontline health workers, national guides for introducing new practices, and simulation-based training to strengthen emergency response.

Launched at the 2025 FIGO World Congress in Cape Town, these first-of-their-kind consolidated PPH guidelines are a key step in implementing the Global Roadmap for Combatting PPH between 2023 and 2030.