WHO, FIGO, and ICM call for earlier detection, faster intervention, and stronger investment in maternal health systems to prevent preventable deaths from childbirth complications.
By Bunmi Yekini
In a landmark move to tackle one of the world’s deadliest childbirth complications, leading reproductive health agencies have unveiled new global guidelines to revolutionise how postpartum haemorrhage (PPH) is prevented, diagnosed, and treated.
The guidelines, jointly released by the World Health Organisation (WHO), the International Federation of Gynaecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM), call for earlier detection, faster intervention, and enhanced training for frontline health workers.
Each year, PPH, defined as excessive bleeding after childbirth, affects millions of women and causes nearly 45,000 deaths globally, making it one of the leading causes of maternal mortality. Even when not fatal, it can leave survivors with lasting physical and mental health effects.
“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 and Care.
“These guidelines are designed to maximise 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.”
The new recommendations, based on the largest-ever global study on PPH published in The Lancet, introduce objective diagnostic criteria to ensure timely and accurate detection.
Traditionally, PPH was diagnosed after a woman lost 500 mL or more of blood. However, the updated guidance urges clinicians to act at 300 mL of blood loss or when abnormal vital signs appear—using calibrated drapes that precisely measure bleeding.
Once PPH is detected, caregivers are advised to immediately implement the MOTIVE bundle, which includes:
- 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
“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, in every context.”
The publication also emphasises prevention through strong antenatal and postnatal care, including the treatment of anaemia, which increases PPH risk and worsens outcomes. Pregnant women are encouraged to take daily iron and folate supplements, while intravenous iron may be administered when faster correction is needed.
Unsafe practices such as routine episiotomies are discouraged, while preventive techniques like perineal massage in late pregnancy are recommended to reduce trauma and bleeding.
During the third stage of labour, the guidelines recommend administering quality-assured uterotonics, preferably oxytocin or heat-stable carbetocin. If these are unavailable, misoprostol may be used as a last resort.
“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, we need more than evidence and protocols. Governments and partners must adopt these recommendations quickly and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past.”
Accompanied by new training and implementation tools developed with UNFPA and other partners, the guidelines include simulation-based learning modules, national adaptation guides, and practical checklists for frontline health workers.
The consolidated document, the first to uniquely focus on PPH, contains 51 recommendations covering prevention, diagnosis, and treatment. It was launched at the 2025 FIGO World Congress in Cape Town, South Africa, marking a major milestone in the Global Roadmap to Combat Postpartum Haemorrhage (2023–2030).
The WHO-led study underpinning the guidelines analysed data from over 300,000 women in 23 countries, offering unprecedented insight into early clinical signs of serious postpartum bleeding.