New global guidelines were released to transform the prevention, diagnosis, and treatment of postpartum hemorrhage (PPH) by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM). Based on the largest study to date, published in The Lancet, these guidelines introduce new objective diagnostic criteria and recommend the E-MOTIVE bundle, an immediate care protocol designed to save lives and reduce global maternal health disparities.
Postpartum hemorrhage, or excessive bleeding after childbirth, is a leading cause of maternal mortality, particularly in low- and lower-middle-income countries.
The study assessed how well various clinical signs could predict maternal death or severe complications. Researchers concluded that “measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding.” They emphasized that treatment should begin even at 300 mL of blood loss, especially when symptoms such as high heart rate or low blood pressure are present.
The updated guidelines call for the immediate application of the E-MOTIVE bundle which includes uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, genital tract examination, and escalation of care if bleeding persists. In rare, severe cases, surgery or blood transfusion may be required to stabilize the woman’s condition.
These comprehensive guidelines, which include 51 recommendations, are supported by new training resources for health workers and policy guides for implementation. “The 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,” said Jeremy Farrar, WHO assistant director-general.
Marking the urgency of the issue, October 5 will now be observed as World PPH Day, reinforcing the commitment to ending preventable maternal deaths and achieving global health equity.
Reference: Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis, Gallos, IoannisBOROVAC-PINHEIRO, Anderson et al. The Lancet, Volume 0, Issue 0
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