Women who lose 300ml of blood after giving birth should be diagnosed with postpartum haemorrhage (PPH) according to new guidelines published by the World Health Organization (WHO), the International Federation of Gynaecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM).

In the past, PPH has only been diagnosed if a woman loses 500ml of blood, but this has often meant that the diagnosis is too late for adequate interventions.

Doctors and midwives are now advised to monitor women closely after birth using a calibrated drape, a simple device that collects and accurately quantifies lost blood.

As soon as PPH is diagnosed, the guidelines recommend the immediate deployment of the MOTIVE bundle. This stands for: Massage of the uterus; Oxytocic drugs to stimulate contractions; Tranexamic acid (TXA) to reduce bleeding; Intravenous fluids; Vaginal and genital tract examination; and Escalation of care if the bleeding persists.

PPH affects millions of women annually and is one of the leading causes of maternal mortality, causing nearly 45,000 deaths. 

Even when not fatal, it can cause lifelong physical and mental health impacts, from major organ damage to hysterectomies, anxiety and trauma.  

“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 Assistant Director-General. 

“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.”

Fast, feasible and effective

Motivation for the change comes from a large study published in The Lancet last week, which analysed 12 datasets involving 312,151 women.

The study found that blood loss of 300ml offered the “preferred sensitivity threshold”, particularly when combined with “any abnormal haemodynamic sign”, such as increased pulse rate or a drop in blood pressure.

In rare cases where bleeding continues, the guidelines also recommend surgery or blood transfusions to safely stabilise the woman.

“Women affected by PPH need care that is fast, feasible, effective and drives progress towards eliminating PPH-related deaths,” said FIGO President Professor Anne-Beatrice Kihara.

The guidelines were launched at the president’s session at FIGO’s world congress in Cape Town, South Africa, on Sunday 5 October, which was also declared as the first World Postpartum Haemorrage Day.

🌟 Today, history is made at #FIGO2025

Together with global leaders, FIGO, @WHO , and ICM have declared 5 October as World Postpartum Haemorrhage Day —
a day of remembrance, action and solidarity with women everywhere.

“Join us in our declaration of World Postpartum Haemorrage… pic.twitter.com/DyLnBCPe8P

— FIGO HQ (@FIGOHQ) October 5, 2025

“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.”

The guidelines also stress good antenatal and postnatal care to mitigate critical risk factors such as anaemia, which increases the likelihood of PPH and worsens outcomes if it occurs. Recommendations for anaemic mothers 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 guidance also discourages routine episiotomies to reduce the likelihood of trauma and severe bleeding after birth.

During the third stage of labour, the guidelines recommend administering medicine to support uterine contraction, particularly oxytocin or carbetocin. 

If intravenous options are not available and the cold chain is unreliable, misoprostol may be used as a last resort.

More evidence and protocols

“Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent, 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.”

According to a commentary in The Lancet, the new guidelines are “an equity intervention” and they align “the prevention–detection–treatment continuum with enablers (eg, supportive infrastructure)” and also state “what not to do when skills or supplies are scarce”.

“The guidelines recognise where women give birth, who is present, and what commodities are reliably available, and they reduce ambiguity that so often paralyses action in the first minutes of a dire emergency.”

Image Credits: Elizabeth Poll/MMV.