Landmark Global Guidelines Aim to Transform Postpartum Haemorrhage Care and Save Thousands of Lives.
CAPE TOWN, South Africa:
In a bold move to reduce one of the world’s deadliest childbirth complications, leading global health organizations today released groundbreaking new guidelines for the prevention, diagnosis, and treatment of postpartum haemorrhage (PPH). The comprehensive recommendations—unveiled at the 2025 FIGO World Congress—are expected to significantly shift how maternal health providers respond to this life-threatening emergency, especially in low-resource settings.
Jointly published by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM), the guidelines call for earlier detection and faster intervention in cases of PPH, which kills nearly 45,000 women every year and affects millions more with lasting health consequences.
“Postpartum haemorrhage is the most dangerous childbirth complication since it can escalate with such alarming speed,” said Dr Jeremy Farrar, WHO’s Assistant Director-General for Health Promotion and Disease Prevention and Care. “While it is not always predictable, deaths are preventable with the right care. These guidelines are designed to maximize impact where the burden is highest and resources are most limited.”
PPH: A Silent Crisis in Maternal Health
Postpartum haemorrhage—defined as excessive bleeding after childbirth—is the leading cause of maternal mortality globally. It can progress rapidly and unpredictably, often without prior risk factors. When not fatal, PPH can lead to severe complications including organ failure, infertility, and psychological trauma.
The new guidelines are based on the largest-ever study on PPH, published today in The Lancet, and they introduce a more sensitive diagnostic threshold to trigger early response. While traditionally diagnosed at 500 mL of blood loss, health workers are now advised to initiate treatment at 300 mL, especially when accompanied by abnormal vital signs.
Objective Diagnosis with Simple Tools
To support early diagnosis, the guidelines advocate for the use of calibrated drapes—low-cost, simple devices that collect and measure blood loss in real time. These tools are essential in busy or under-resourced labour wards where subjective estimations often delay treatment.
The MOTIVE Bundle: A Rapid-Response Protocol
Once PPH is diagnosed, the guidelines recommend immediate activation of the MOTIVE bundle, a structured set of actions designed to stop bleeding and stabilize the mother:
- 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 continues
If bleeding persists, interventions such as surgery or blood transfusion should be implemented as emergency stabilizing measures.
“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.”
Focus on Prevention and Antenatal Support
The guidelines also place strong emphasis on prevention, particularly the management of anaemia—a common condition in pregnant women that worsens PPH outcomes. Recommendations include:
- Daily oral iron and folate supplements during pregnancy
- Intravenous iron therapy in cases of severe anaemia or after PPH
- Discouraging unsafe practices like routine episiotomies
- Encouraging perineal massage in late pregnancy to reduce trauma during childbirth
During the third stage of labour, the administration of a uterotonic drug remains crucial. Preferred options include oxytocin or heat-stable carbetocin. If these are unavailable and the cold chain is unreliable, misoprostol may be used as a last resort.
A Global Call to Action
The release of these guidelines comes with a strong appeal to governments, donors, and health systems to invest in maternal care and frontline workers.
“Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent OBE, Chief Midwife of ICM. “These guidelines are a game-changer. But to end preventable deaths from PPH, we need more than evidence and protocols. We need commitment, funding, and action.”
The launch is supported by a suite of training materials and implementation tools, including:
- Hands-on modules for frontline providers
- National-level integration strategies
- Simulation-based emergency response training
A Major Milestone in Global Maternal Health
This marks the first consolidated international guideline focused solely on PPH, forming a cornerstone of the Global Roadmap to Combat Postpartum Haemorrhage (2023–2030). The initiative aims to eliminate preventable maternal deaths due to PPH over the next five years.
“This is more than a medical breakthrough—it’s a blueprint for saving lives,” said Dr Farrar. “By adopting these guidelines, we take a vital step toward ensuring no woman dies while giving life.”
