Defined as excessive bleeding after childbirth, PPH affects millions of women annually and causes nearly 45 000 deaths, making it one of the leading causes of maternal mortality globally. Even when not fatal, it can lead to lifelong physical and mental health impacts, from major organ damage to hysterectomies, anxiety and trauma.
Published by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM), the guidelines introduce new objective diagnostic criteria for detecting PPH, based on the largest study on the topic to date – also published today in The Lancet.
Typically, PPH has been diagnosed as a blood loss of 500 mL or more. Now, clinicians are also advised to act when the blood loss reaches 300 mL, and any abnormal vital signs have been observed. To diagnose PPH early, doctors and midwives are advised to monitor women closely after birth and use calibrated drapes – simple devices that collect and accurately quantify lost blood – so that they can act immediately when criteria are met.
Massage of the uterus;Oxytocic drugs to stimulate contractions;Tranexamic acid (TXA) to reduce bleeding;Intravenous fluids;Vaginal and genital tract examination; andEscalation of care if bleeding persists.
In rare cases where bleeding continues, the guidelines recommend effective interventions such as surgery or blood transfusion to safely stabilize a woman’s condition until further treatment becomes available.
Reducing risks through effective prevention
The guidelines emphasize the importance of good antenatal and postnatal care to mitigate critical risk factors such as anaemia, which is highly prevalent in low- and lower-middle income countries. Anaemia 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.
During the third stage of labour, the guidelines recommend administering a quality-assured uterotonic to support uterine contraction, preferably oxytocin or heat-stable carbetocin as an alternative. If intravenous options are not available and the cold chain is unreliable, misoprostol may be used as a last resort.
The guidelines are accompanied by a suite of training and implementation resources, developed with partners including UNFPA. These tools consist of practical modules for frontline health workers, national-level guides for introducing new practices, and simulation-based training to strengthen emergency response.
Notes for editors
The guidelines contain 51 recommendations, drawing together existing and new evidence-based recommendations relevant to preventing, diagnosing and treating PPH.
Gallos I, Williams CR, Price MJ, Tobias A, Devall A, Allotey J et al. Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis. Lancet. 2025 ( doi.org/10.1016/S0140-6736(25)01639-3).
Funding for the guideline was provided through the Gates Foundation.
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