WHO issues new global norms to curb post-birth bleeding
Cape Town/Geneva: Three leading global health bodies — the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) — have jointly issued updated global guidelines aimed at improving the prevention, diagnosis, and management of postpartum haemorrhage (PPH), the leading cause of maternal mortality worldwide. The recommendations were released on Friday in Cape Town and Geneva during the 2025 FIGO World Congress in South Africa.
Postpartum haemorrhage, defined as excessive bleeding following childbirth, affects millions of women each year and is responsible for nearly 45,000 maternal deaths globally. Even when not fatal, it can cause serious and lasting health consequences, including organ damage, hysterectomy, and psychological 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’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 guidance introduces objective diagnostic criteria for detecting PPH earlier, based on findings from the largest international study on the topic, published simultaneously in The Lancet. Conducted by WHO and the UN Special Programme on Human Reproduction (HRP), the study analysed data from more than 300,000 women across 23 countries.
Traditionally, PPH has been defined as blood loss of 500 millilitres or more within 24 hours of delivery. Under the revised recommendations, clinicians are advised to initiate action when blood loss reaches 300 millilitres, accompanied by any abnormal vital signs. The agencies note that many cases occur without identifiable risk factors, which makes early detection and prompt response essential.
To improve detection, the guidelines encourage close postnatal monitoring and the use of calibrated drapes, simple devices designed to collect and accurately measure blood loss. These tools can help health workers act quickly once the diagnostic threshold is reached, particularly in settings with limited staff or stretched resources.
Once PPH is diagnosed, the guidelines recommend immediate application of the MOTIVE bundle of six actions:
- Massage of the uterus to stimulate contraction;
- Oxytocic drugs to promote uterine contraction;
- Tranexamic acid (TXA) to reduce bleeding;
- Intravenous fluids to maintain blood circulation;
- Vaginal and genital tract examination to identify injuries or retained tissue; and
- Escalation of care if bleeding persists.
If bleeding continues despite these steps, further interventions such as surgical procedures or blood transfusions are advised to stabilise the patient until advanced treatment is available.
“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. 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 address preventive measures and emphasise the importance of good antenatal and postnatal care to manage risk factors such as anaemia, which is highly prevalent in low- and lower-middle-income countries. Anaemia increases both the risk and severity of PPH. Recommendations include daily oral iron and folate supplementation during pregnancy and intravenous iron transfusions when rapid correction is required, including after a haemorrhage or when oral therapy fails.
The publication discourages routine episiotomies, which can increase trauma and blood loss, and promotes perineal massage during late pregnancy to reduce the likelihood of perineal injury during childbirth.
During the third stage of labour, the guidelines recommend administration of a quality-assured uterotonic to support uterine contraction. Oxytocin remains the preferred drug, with heat-stable carbetocin as an alternative where refrigeration is unreliable. In facilities lacking intravenous drugs or reliable cold chains, 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 provide clear, evidence-based direction. But to end preventable deaths from PPH, governments, health systems, donors, and partners must act swiftly, adopt these recommendations, and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past.”
To support implementation, WHO, FIGO, and ICM have released a suite of training and practical resources developed with partners, including the United Nations Population Fund (UNFPA). These include hands-on modules for frontline health workers, national-level guides for adapting the new recommendations, and simulation-based training exercises to improve emergency obstetric response.
The consolidated guidelines bring together 51 evidence-based recommendations, integrating both new and existing measures related to the prevention, diagnosis, and treatment of postpartum haemorrhage. They are considered a key step in advancing the Global Roadmap for Combatting PPH (2023–2030), a global strategy to reduce maternal deaths from excessive bleeding.
The WHO–HRP study underlying the new diagnostic guidance has been published in The Lancet under the title “Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis” (Gallos I, Williams CR, Price MJ, Tobias A, Devall A, Allotey J et al., 2025. Funding for the development of the guidelines was provided through the Bill & Melinda Gates Foundation.
The agencies said the updated framework is intended to help health workers in both high- and low-resource settings adopt standard, evidence-based approaches to detecting and treating excessive postpartum bleeding — one of the most preventable causes of maternal mortality worldwide.
– global bihari bureau
