The World Health Organization (WHO) and its global partners have released updated guidelines on October 5, 2025, to improve the detection, management, and prevention of postpartum hemorrhage (PPH). The new recommendations focus on early diagnosis, consistent treatment methods, and better support for healthcare systems in low and middle-income countries.
Postpartum hemorrhage (PPH)—traditionally defined by blood loss thresholds—now encompasses any blood loss ≥ 1,000 mL accompanied by signs of hypovolemia.
It typically presents within 24 hours of delivery (primary) or up to 12 weeks postpartum (secondary). The main causation are often captured in the “4 T’s”: uterine tone, trauma, tissue, and thrombin.1
Each year, millions of women are affected, with the condition claiming an estimated 70,000 lives globally. 2
Postpartum hemorrhage, or excessive bleeding after childbirth, remains one of the leading causes of maternal death worldwide. Many deaths occur due to delayed recognition of blood loss, inconsistent clinical practices, and limited access to essential medicines.
The new WHO guidelines aim to standardize how healthcare workers identify and respond to PPH to save more mothers’ lives.
Early risk assessment: Every woman should be screened for risk factors before and after delivery using a standardized tool.
Accurate measurement of blood loss: Health workers are encouraged to use calibrated drapes or weighing methods to identify bleeding quickly and accurately.
Standard treatment bundles: Clinicians should follow a defined set of steps that include uterotonics, intravenous fluids, tranexamic acid, uterine massage, and timely escalation if bleeding continues.
Clear escalation protocols: If first-line treatments fail, medical teams should move to second-tier interventions such as balloon tamponade, surgical repair, or hysterectomy.
System strengthening: The WHO urges governments to improve training, supply chains, and hospital infrastructure to support timely treatment.
The new recommendations are based on a global meta-analysis published in The Lancet. The study reviewed data from over 60 years of research and identified that uterine atony, or the failure of the uterus to contract, accounts for about 70.6 percent of postpartum hemorrhage cases. Other significant causes include genital tract trauma (16.9 percent), retained placenta (16.4 percent), abnormal placentation, and blood clotting disorders.
The study also identified several risk factors strongly linked to PPH, including:
Low haemoglobin or anaemia
History of postpartum hemorrhage
Cesarean birth
Placenta previa or abnormal placental attachment
Infection or sepsis
Assisted reproductive technologies
Fetal macrosomia (birthweight above 4,500 grams)
Shoulder dystocia during labor
Limited or no antenatal care
Since many of these factors can be identified before childbirth, the WHO emphasizes prevention and preparedness as central to its approach.
Low-resource health systems continue to face shortages of trained personnel, uterotonic drugs, and blood-loss measuring tools. The WHO encourages the use of new solutions such as heat-stable oxytocin and easy-to-use balloon tamponade devices, which can help bridge care gaps in rural settings.
In countries like India, where maternal mortality remains a major concern, adopting these WHO guidelines could make a critical difference.
What is postpartum hemorrhage (PPH)?
Postpartum hemorrhage refers to excessive bleeding after childbirth. It usually occurs within 24 hours after delivery but can also happen later. It remains one of the leading causes of maternal deaths globally.
Why did the WHO release new guidelines on postpartum hemorrhage?
The World Health Organization updated its recommendations to address gaps in early detection and management of PPH. The goal is to reduce maternal deaths by improving diagnosis, treatment, and prevention across healthcare settings.
What are the key changes in the new guidelines?
The guidelines emphasize early risk assessment, accurate measurement of blood loss, standardized treatment bundles, and rapid escalation of care. They also focus on strengthening health systems through better training and supply chains.
What are the most common causes of postpartum hemorrhage?
The leading cause of PPH is uterine atony, when the uterus fails to contract properly after birth. Other causes include genital tract trauma, retained placenta, abnormal placentation, and blood clotting disorders.
Who is at higher risk of postpartum hemorrhage?
Women with anemia, a history of PPH, cesarean delivery, placenta previa, infection, or large babies are at greater risk. Those who lack access to prenatal care also face a higher chance of complications.
How can postpartum hemorrhage be prevented?
Prevention involves assessing risk early, using uterotonic drugs immediately after delivery, and ensuring trained staff and emergency resources are available. Regular antenatal care also helps identify risk factors before birth.
References:
1. Wormer, Kelly C., Radia T. Jamil, and Suzanne B. Bryant. “Postpartum Hemorrhage.” In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, January 2025–. Updated July 19, 2024. Accessed October 10, 2025. https://www.ncbi.nlm.nih.gov/books/NBK499988/.
2. World Health Organization. “Postpartum Haemorrhage.” Sexual and Reproductive Health and Research (SRH). Last modified October 11, 2023. Accessed October 10, 2025. https://www.who.int/teams/sexual-and-reproductive-health-and-research-(srh)/areas-of-work/maternal-and-perinatal-health/postpartum-haemorrhage.
3.World Health Organization. “Global Health Agencies Issue New Recommendations to Help End Deaths from Postpartum Haemorrhage.” WHO, October 5, 2025. Accessed October 10, 2025. https://www.who.int/news/item/05-10-2025-global-health-agencies-issue-new-recommendations-to-help-end-deaths-from-postpartum-haemorrhage.
(Rh/ARC/MSM)