WHO releases new guidelines to prevent maternal deaths from childbirth bleeding

The World Health Organization (WHO), together with the International Federation of Gynaecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM), has released new global guidelines on the prevention, diagnosis, and treatment of postpartum haemorrhage (PPH)—a leading cause of maternal deaths worldwide.

The updated recommendations emphasize earlier detection and faster intervention, measures that could save the lives of tens of thousands of women every year.

PPH, defined as excessive bleeding after childbirth, affects millions of women globally and causes nearly 45,000 deaths annually, according to WHO. Even when not fatal, it can result in lifelong complications, including organ damage, infertility, anxiety, and trauma.

“Postpartum haemorrhage is the most dangerous childbirth complication because it can escalate with alarming speed. While it’s not always predictable, deaths are preventable with the right care,” said Dr. Jeremy Farrar, WHO Assistant Director-General for Health Promotion, Disease Prevention and Care. “These guidelines aim to maximize impact where the burden is greatest and resources are most limited—helping ensure more women survive childbirth and return home safely to their families.”

New Diagnostic Criteria and Early Intervention

The new guidelines introduce objective diagnostic criteria for earlier and more accurate detection of PPH. Since many cases occur without identifiable risk factors, WHO urges health workers to closely monitor women immediately after birth using calibrated drapes to measure blood loss precisely.

Traditionally, PPH was diagnosed after a blood loss of 500 millilitres or more. Under the new recommendations, clinicians are advised to act at 300 millilitres, allowing life-saving interventions to begin sooner.

Once PPH is diagnosed, health workers are instructed to immediately deploy the MOTIVE bundle of actions, which includes:

• Massage of the uterus;
• Oxytocic drugs to stimulate contractions;
• Tranexamic acid (TXA) to reduce bleeding;
• Intravenous fluids;
• Vaginal and genital tract examination; and
• Escalation of care if bleeding persists.

In severe or unresponsive cases, the guidelines recommend timely access to surgical interventions or blood transfusions to stabilize the mother until further treatment is available.

“Women affected by PPH need care that is fast, feasible, and effective,” said Professor Ann Beatrice Kihara, President of FIGO. “These guidelines take a proactive approach—focusing on readiness, recognition, and response—to empower health workers to deliver the right care at the right time, in every setting.”

Beyond emergency response, the guidelines underscore the importance of comprehensive antenatal and postnatal care to reduce risk factors such as anaemia. They also caution against unsafe practices like routine episiotomies, while encouraging perineal massage in late pregnancy to reduce trauma and bleeding.

“Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent OBE, ICM’s Midwife. “These guidelines are a game-changer. But to end preventable deaths from PPH, we need more than protocols—we need governments, health systems, and donors to act quickly and invest in midwives and maternal care.”

The guidelines are accompanied by new training and implementation resources, developed in collaboration with partners including UNFPA, and are being launched at the 2025 FIGO World Congress in Cape Town, South Africa.

According to WHO, this marks a critical milestone in the rollout of the Global Roadmap to Combat Postpartum Haemorrhage (2023–2030), which aims to eliminate preventable PPH-related deaths and ensure safer childbirth for women everywhere.