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Guideline

Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage

Year of Publication
2025
Issuing Institution
World Health Organization
Links
WHO IRIS

Recommendations

53 included recommendations

To identify women at risk of adverse outcomes from postpartum bleeding and initiate first-response treatment, it is recommended to use the following criteria: objectively measured blood loss threshold of ≥300 mL with any abnormal haemodynamic sign (pulse >100 bpm, shock index >1, systolic blood pressure <100 mmHg, or diastolic blood pressure <60 mmHg), or objectively measured blood loss of ≥500 mL, whichever occurs first within 24 hours after birth, and with particular vigilance during the first 2 hours

Status
New

Recommended

A standardized and timely approach to the management of postpartum haemorrhage, comprising an objective assessment of blood loss and use of a treatment bundle supported by an implementation strategy, is recommended for all women having a vaginal birth. The care bundle for first-line treatment of postpartum haemorrhage should include rapid institution of uterine massage, administration of an oxytocic agent and tranexamic acid, intravenous fluids, examination of the genital tract and escalation of care

Status
New

Recommended

Uterine balloon tamponade is recommended for the treatment of postpartum haemorrhage due to uterine atony after vaginal birth in women who do not respond to standard first-line treatment, provided the following conditions are met:  Immediate recourse to surgical intervention and access to blood products is possible if needed.  A primary postpartum haemorrhage first-line treatment protocol (including the use of uterotonics, tranexamic acid, intravenous fluids) is available and routinely implemented.  Other causes of postpartum haemorrhage (retained placental tissue, trauma) can be reasonably excluded.  The procedure is performed by health personnel who are trained and skilled in the management of postpartum haemorrhage, including the use of uterine balloon tamponade.  Maternal condition can be regularly and adequately monitored for prompt identification of any signs of deterioration.

Status
New

Context specific recommendation

Only in specific contexts