Translation. Region: Russian Federal
Source: United Nations – United Nations –
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October 4, 2025 Healthcare
Leading reproductive health organizations today presented new guidelines calling for a radical rethinking of approaches to the prevention, diagnosis, and treatment of postpartum hemorrhage (PPH). The document emphasizes the need for earlier detection and rapid intervention—measures that could save tens of thousands of women each year.
Excessive bleeding after childbirth is one of the leading causes maternal mortality – affects millions of women annually and causes approximately 45,000 deaths. Even if PPH is not fatal, it can cause serious and long-term health problems, ranging from organ dysfunction to hysterectomies (uterine removal) and post-traumatic stress disorder.
"Postpartum hemorrhage is the most dangerous complication of childbirth because it develops with astonishing speed. While it cannot always be predicted, deaths can be prevented with the right care," said Dr. Jeremy Farrar, Assistant Director for Public Health Promotion, Disease Prevention and Control at the World Health Organization (WHO).
Early diagnosis and rapid response
New guidelines developed by the WHO, the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) introduce updated criteria for diagnosing PPH. They are based on the largest study on the topic, also published today in the medical journal The Lancet.
Traditionally, PPH was diagnosed with blood loss of 500 ml or more. Now, doctors and midwives are advised to take action at 300 ml of blood loss if abnormal vital signs are observed. To detect PPH early, specialists are advised to closely monitor women after childbirth and use special wipes to accurately measure blood loss.
Once diagnosed, it is recommended to apply immediately. MOTIVE action package, including uterine massage, the use of oxytocin to stimulate contractions and tranexamic acid (TXA) to reduce bleeding, intravenous fluids, examination of the genital tract, and transition to advanced treatment if bleeding continues. In rare cases, surgical interventions or blood transfusions may be required.
Prevention and risk reduction
The guidelines emphasize the importance of high-quality antenatal and postnatal care to reduce risk factors such as anemia. Anemia, which is common in low- and middle-income countries, increases the risk of PPH and worsens its consequences. Women with anemia are recommended to take daily iron and folic acid supplements during pregnancy and, if necessary, intravenous iron transfusions.
The document also warns against unsafe practices such as routine episiotomy (perineal incision) and recommends preventative methods such as perineal massage in late pregnancy to reduce the risk of injury and severe bleeding.
During the third stage of labor, the use of a high-quality uterotonic (a drug that stimulates uterine contractions) is recommended, preferably oxytocin or heat-stable carbetocin. If intravenous medications are unavailable, misoprostol can be used as a last resort.
The recommendations, along with accompanying training materials, were presented at the FIGO 2025 World Congress in Cape Town, South Africa.
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