On October 5, 2025, three major reproductive health organisations released new guidelines to tackle postpartum haemorrhage (PPH), the leading cause of maternal deaths worldwide.
The World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) published the recommendations after a major study in The Lancet. The guidelines call for earlier diagnosis and faster treatment to prevent avoidable deaths.
New rules redefine childbirth bleeding
PPH is defined as excessive bleeding after childbirth. It affects millions of women each year and causes nearly 45,000 deaths, mostly in low-income countries. Even when not fatal, it can leave women with lifelong health problems, including organ damage and hysterectomies.
For decades, PPH was diagnosed when blood loss reached 500 millilitres. The new guidance lowers that threshold to 300 millilitres when combined with abnormal vital signs such as rapid pulse or low blood pressure. Experts say this change could help health workers act faster.
“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, WHO’s Assistant Director-General for Health Promotion and Disease Prevention.
New measures for quicker treatment
The guidelines also recommend using calibrated drapes after delivery. These simple tools collect and measure blood, allowing doctors and midwives to diagnose PPH more accurately.
• Massage of the uterus
• Oxytocic drugs to stimulate contractions
• Tranexamic acid to reduce bleeding
• Intravenous fluids
• Vaginal and genital tract examination and
• Escalation of care if bleeding persists.
Once diagnosed, the guidelines call for immediate action through the E-MOTIVE bundle. This includes massaging the uterus, giving oxytocic drugs, administering tranexamic acid to reduce bleeding, providing intravenous fluids, examining the genital tract, and escalating care if bleeding continues. In severe cases, surgery or blood transfusion may be required.
“Women affected by PPH need care that is fast, feasible and effective,” said Professor Anne-Beatrice Kihara, President of FIGO. “These guidelines take a proactive approach of readiness, recognition and response. They are designed to empower health workers to deliver the right care at the right time.”
The Lancet study that informed the recommendations analysed more than 300,000 cases. It found that early signs of bleeding below 500 millilitres were strong predictors of severe outcomes if left untreated.
Global effort to cut maternal deaths
The guidance also highlights prevention measures. It stresses the importance of treating anaemia during pregnancy, a condition that increases the risk of severe bleeding. Daily iron and folate supplements are advised, with intravenous iron transfusions recommended when rapid correction is needed.
Routine episiotomies, which can increase bleeding risk, are discouraged. Instead, preventive practices such as perineal massage in late pregnancy are promoted. During the third stage of labour, the use of uterotonic drugs such as oxytocin or carbetocin is recommended.
Midwives play a central role in applying these measures. “Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent, Chief Midwife at ICM. “But to end preventable deaths, governments and health systems must act quickly, adopt these guidelines, and invest in maternal care.”
The guidelines were launched at the FIGO World Congress in Cape Town, where October 5 was declared the first World Postpartum Haemorrhage Day. The move signals a growing global effort to reduce maternal mortality and meet the Sustainable Development Goal of fewer than 70 maternal deaths per 100,000 live births by 2030.
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