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Global health agencies issue new recommendations to help end deaths from postpartum haemorrhage

 

Embargoed until 00:30 CEST/Geneva on 5 October 2025 –Through landmark new guidelines released today, leading reproductive health agencies are calling for a major shift in how postpartum haemorrhage (PPH) is prevented, diagnosed and treated. The recommendations highlight the urgent need for earlier detection and faster intervention — steps that could save the lives of tens of thousands of women each year.

Defined as excessive bleeding after childbirth, PPH affects around 14 million women annually and causes nearly 45 000 deaths, making it one of the world’s leading causes of maternal mortality. Even when not fatal, it can lead to lifelong physical and mental health impacts, from major organ damage to hysterectomies, anxiety and trauma.

“Postpartum haemorrhage is one of the most dangerous childbirth complications since it can escalate with such alarming speed. While it is not always predictable, fatalities are highly preventable with the right care,” said Dr Jeremy Farrar, Assistant Director-General for Health Promotion and Disease Prevention and Control. “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 diagnostic criteria for rapid action

Published by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM), the guidelines introduce new objective diagnostic criteria for detecting PPH, based on the largest study on the topic to date – also published today in The Lancet.

Many PPH cases occur without identifiable risk factors, meaning early detection and rapid response is critical. Yet in many settings, especially where healthcare resources and labour wards are overstretched, delays in treatment result in devastating consequences.

Typically, PPH has been diagnosed at a threshold of 500 mL of blood loss. Now, clinicians are also advised to act when there is 300 mL blood loss along with any abnormal vital signs. To diagnose PPH early, doctors and midwives are advised to monitor women closely after birth and use calibrated drapes – simple devices that collect and accurately quantify blood loss – so as to act immediately when criteria are met.

Once PPH is diagnosed, the guidelines recommend immediate deployment of the MOTIVE bundle:

  • 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, the guidelines outline effective interventions to safely stabilize a woman’s condition until further treatment is available, such as surgery or blood transfusion.

“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.”

Reducing risks through effective prevention

The guidelines emphasize the importance of good antenatal and postnatal care to mitigate critical risk factors such as anaemia, which is highly prevalent in low and lower-middle income countries and both increases the likelihood of PPH and worsens outcomes if it occurs. Recommendations include daily oral iron and folate during pregnancy and intravenous iron transfusions when rapid correction is needed – including after PPH – or if oral therapy fails.

The publication also discourages unsafe practices such as routine episiotomies while promoting preventive techniques like perineal massage in late pregnancy, so as to reduce the likelihood of trauma and severe bleeding after birth.

During the third stage of labour, the guidelines recommend administering a quality-assured uterotonic to help the uterus contract: either oxytocin as the preferred drug of choice or heat-stable carbetocin as an alternative if the cold chain is unreliable, with misoprostol as a last resort should intravenous options not be available.

“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 guidelines are accompanied by a suite of training and implementation resources, developed with partners including UNFPA. These tools consist of practical modules for frontline health workers, national-level guides for introducing new practices, and simulation-based training to strengthen emergency response.

These consolidated guidelines – the first to uniquely focus on PPH – are being launched at the 2025 FIGO World Congress in Cape Town, South Africa. They are a crucial step in the implementation of the Global Roadmap for Combatting PPH between 2023 and 2030.

 

Notes for editors

  • The guidelines contain 51 recommendations, drawing together existing and new evidence-based recommendations relevant to preventing, diagnosing and treating PPH.
  • A new study from WHO and the UN Special Programme on Human Reproduction (HRP) on diagnostic accuracy of indicators of serious postpartum bleeding involving over 300 000 women across 23 countries was also published today in The Lancet:
  • Gallos I, Williams CR, Price MJ, Tobias A, Devall A, Allotey J et al. Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis. Lancet. 2025 (https://doi.org/10.1016/S0140-6736(25)01639-3).
  • A commentary on the guidelines is also published today in the Lancet Global Health: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00404-8/fulltext 
  • Funding for the guideline was provided through the Gates Foundation.

 

For further information contact ICM at [email protected]