WHO Unveils Global Guidelines to Tackle Deadly Postpartum Haemorrhage

In a historic step toward improving maternal survival, the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) have jointly released groundbreaking global guidelines to prevent and manage postpartum haemorrhage (PPH) — the leading cause of maternal deaths worldwide.

Launched at the 2025 FIGO World Congress in Cape Town, South Africa, the new framework calls for a radical shift in how PPH is diagnosed, prevented, and treated, emphasizing early detection and rapid, coordinated response to prevent unnecessary deaths.

PPH, defined as severe bleeding following childbirth, affects millions of women each year, leading to nearly 45,000 deaths annually—the majority occurring in low- and middle-income countries. Beyond mortality, survivors often face devastating long-term consequences, from organ failure and infertility to chronic psychological trauma.

A Life-Saving Shift: Acting Sooner to Prevent Deaths

The updated guidelines mark the most significant change in decades to global maternal health protocols. Traditionally, PPH was diagnosed when blood loss exceeded 500 millilitres after childbirth. However, research shows that waiting until this threshold is reached often results in dangerous delays.

Now, health workers are urged to act immediately when blood loss reaches 300 millilitres and any abnormal vital signs—such as rapid pulse or low blood pressure—are detected. This early threshold allows life-saving interventions before a woman’s condition deteriorates.

Clinicians are also advised to use calibrated drapes, simple yet effective tools that accurately measure blood loss in real time, replacing the unreliable visual estimates that have long hindered timely diagnosis.

“Postpartum haemorrhage is the most dangerous childbirth complication because it can escalate with alarming speed. These new criteria will help save lives, especially where health systems are stretched,” said Dr. Jeremy Farrar, WHO Assistant Director-General for Health Promotion and Disease Prevention and Care.

The MOTIVE Bundle: A Comprehensive, Rapid-Response Approach

A key feature of the new guidelines is the MOTIVE bundle, an evidence-based protocol designed to ensure rapid and coordinated action once PPH is diagnosed. The acronym stands for:

• Massage of the uterus to stimulate contraction

• Oxytocic drugs to strengthen uterine tightening

• Tranexamic acid (TXA) to reduce blood loss

• Intravenous fluids to maintain circulation

• Vaginal and genital tract examination to identify trauma or retained tissue

• Escalation of care if bleeding continues

These steps must be carried out simultaneously and without delay, ensuring that treatment begins within minutes of diagnosis.

“Women affected by PPH need care that is fast, feasible, and effective,” said Professor Anne Beatrice Kihara, President of FIGO. “Our focus is readiness, recognition, and rapid response. The MOTIVE bundle gives healthcare teams the tools to act decisively in any setting.”

Prevention First: Tackling Anaemia and Unsafe Practices

Beyond emergency care, the guidelines underscore the importance of preventing PPH before it occurs. One major focus is on addressing maternal anaemia, a condition that increases both the risk and severity of postpartum bleeding.

WHO recommends:

• Daily iron and folate supplements during pregnancy

• Intravenous iron infusions when oral therapy fails or rapid correction is needed

• Treatment of anaemia even after childbirth, particularly if PPH has occurred

The guidelines also discourage routine episiotomies — surgical cuts to the perineum — which often lead to unnecessary bleeding. Instead, they encourage perineal massage in late pregnancy to naturally prepare the tissues for birth.

During the third stage of labour, healthcare providers should administer a uterotonic drug — preferably oxytocin or heat-stable carbetocin — to prevent uterine atony, the main cause of PPH. Where refrigeration is not feasible, misoprostol remains a viable backup.

Empowering Midwives and Frontline Workers

The new recommendations stress the vital role of midwives in detecting and managing PPH, especially in resource-limited regions where they are often the first — and only — point of care.

“Midwives know how quickly postpartum haemorrhage can escalate and claim lives,” said Professor Jacqueline Dunkley-Bent OBE, Chief Midwife of ICM. “These guidelines are a game-changer, but to make a difference, governments and donors must act now — by funding training, staffing, and maternal health systems.”

To support implementation, WHO and its partners, including UNFPA, have developed a comprehensive training and implementation toolkit, featuring:

• Step-by-step clinical manuals

• Simulation-based emergency response training

• National policy guides for scaling up new practices

These tools aim to help countries integrate the guidelines into existing maternal health frameworks and monitor progress toward PPH reduction goals.

Global Commitment to Ending Preventable Maternal Deaths

The guidelines align with the Global Roadmap to Combat Postpartum Haemorrhage (2023–2030), a strategic plan uniting global health actors behind a shared goal: ending preventable PPH-related deaths within the decade.

By emphasizing early recognition, standardized protocols, and equity in maternal care, the new framework represents a decisive step toward achieving Sustainable Development Goal 3.1 — reducing global maternal mortality to fewer than 70 deaths per 100,000 live births by 2030.

“Every woman deserves to survive childbirth,” Dr. Farrar said. “With these guidelines, we are one step closer to making that a global reality.”

The Way Forward

Adopting these recommendations will require political commitment, financial investment, and collaboration between governments, donors, and healthcare providers. WHO and its partners are urging all countries to update national clinical protocols in line with the new evidence.

Experts agree that if implemented universally, the updated approach could save tens of thousands of lives each year, particularly in sub-Saharan Africa and South Asia, where the burden of maternal deaths remains highest.

With the launch of these landmark guidelines, the global health community is united in its mission to ensure that no woman dies while giving life.