By Ayomide Otitoju
The World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) have unveiled groundbreaking guidelines aimed at transforming how postpartum haemorrhage (PPH) — the leading cause of maternal deaths worldwide — is prevented, diagnosed, and treated.
Released on Sunday at the 2025 FIGO World Congress in Cape Town, South Africa, the new framework emphasizes earlier detection and faster intervention, potentially saving tens of thousands of lives each year.
PPH, defined as excessive bleeding after childbirth, affects millions of women annually and causes about 45,000 deaths globally. The new recommendations introduce objective diagnostic criteria, including prompt clinical action when blood loss reaches 300 mL accompanied by abnormal vital signs — lowering the previous threshold of 500 mL.
“Postpartum haemorrhage is the most dangerous childbirth complication, but deaths are preventable with the right care,” said Dr. Jeremy Farrar, WHO’s Assistant Director-General for Health Promotion and Disease Prevention and Care.
The guidelines also call for the use of calibrated drapes to measure blood loss accurately and immediate activation of a standardized “MOTIVE” response bundle, which includes:
Massage of the uterus;
Oxytocic drugs to stimulate contractions;
Tranexamic acid (TXA) to reduce bleeding;
Intravenous fluids for stabilization;
Vaginal/genital tract examination; and
Escalation of care if bleeding persists.
In severe cases, interventions such as surgery or blood transfusion are recommended to stabilize patients.
FIGO President, Professor Anne Beatrice Kihara, said the guidelines promote a proactive “readiness, recognition, and response” approach to save lives. “They empower health workers to deliver the right care at the right time, especially in resource-limited settings,” she added.
The recommendations also highlight the importance of addressing anaemia — a major PPH risk factor — through iron and folate supplementation during pregnancy and, where necessary, intravenous iron therapy. Unsafe practices such as routine episiotomies are discouraged, while preventive measures like perineal massage are promoted.
Professor Jacqueline Dunkley-Bent OBE, Chief Midwife of ICM, described the guidelines as a “game-changer,” calling on governments and health systems to swiftly adopt and fund their implementation.
Accompanied by training resources developed with UNFPA, the guidelines represent the first comprehensive global standard focused exclusively on PPH and align with the Global Roadmap for Combatting Postpartum Haemorrhage (2023–2030).
“These recommendations mark a turning point in maternal health,” said Dr. Farrar. “With earlier action and better tools, more women can survive childbirth and return home safely to their families.”
