Leading global health agencies have unveiled comprehensive new guidelines aimed at significantly reducing deaths from postpartum haemorrhage (PPH). Released on March 15, 2024, these recommendations emphasize the urgent need for improved detection and intervention strategies to save the lives of tens of thousands of women each year.
PPH, characterized by excessive bleeding following childbirth, affects millions of women globally and is responsible for nearly 45,000 deaths annually, making it one of the foremost causes of maternal mortality. Beyond fatal outcomes, PPH can lead to severe long-term health issues, including organ damage, hysterectomies, and mental health challenges such as anxiety and trauma.
Dr. Jeremy Farrar, Assistant Director-General for Health Promotion and Disease Prevention and Care at the World Health Organization (WHO), stated, “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.”
New Diagnostic Criteria and Treatment Protocols
The guidelines, published by the WHO, the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM), introduce new objective criteria for diagnosing PPH. Based on the largest study on the topic, also published in The Lancet, the updated standards suggest that clinicians should act when blood loss reaches 300 mL, rather than the previously accepted threshold of 500 mL. This shift aims to facilitate earlier intervention, particularly in settings where healthcare resources are limited and treatment delays can have dire consequences.
To enhance early detection, healthcare providers are encouraged to closely monitor women after childbirth and utilize calibrated drapes to accurately measure blood loss. Once PPH is diagnosed, the guidelines advocate for immediate implementation of the MOTIVE bundle of actions, which includes various interventions designed to stabilize a woman’s condition quickly.
In cases where bleeding persists, effective treatments such as surgical interventions or blood transfusions are recommended to ensure the woman’s safety until further care is available.
Professor Anne Beatrice Kihara, President of FIGO, emphasized the need for timely and effective care, stating, “Women affected by PPH need care that is fast, feasible, effective, and drives progress towards eliminating PPH-related deaths.”
A Comprehensive Approach to Maternal Health
The guidelines also stress the importance of robust antenatal and postnatal care to address critical risk factors, such as anaemia, which is prevalent in low- and lower-middle-income countries. To mitigate these risks, recommendations include daily oral iron and folate supplementation during pregnancy, as well as intravenous iron transfusions when necessary.
Additionally, the guidelines discourage unsafe practices such as routine episiotomies and advocate for preventive techniques like perineal massage during late pregnancy to reduce the likelihood of trauma and severe bleeding after birth.
During the third stage of labour, healthcare providers are advised to administer a quality-assured uterotonic to promote uterine contractions, with oxytocin being the preferred choice. In situations where intravenous options are unavailable, misoprostol may be considered as a last resort.
Professor Jacqueline Dunkley-Bent OBE, Chief Midwife of the ICM, remarked on the significance of these guidelines: “Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives. These guidelines are a game-changer.”
To facilitate implementation, the guidelines are accompanied by a suite of training resources developed in collaboration with partners such as UNFPA. These resources include practical training modules for frontline health workers and national-level guides for introducing new practices.
The launch of these consolidated guidelines, the first to focus specifically on PPH, is set to take place during the 2025 FIGO World Congress in Cape Town, South Africa. This initiative represents a crucial step in the Global roadmap to combat postpartum haemorrhage between 2023 and 2030, aiming to ensure that fewer women face life-threatening complications during childbirth.
With these new protocols, health agencies are calling for immediate action from governments, health systems, and donors to invest in maternal care and prioritize the implementation of these life-saving recommendations.
