Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Bimanual uterine compression is recommended as a temporizing measure until appropriate care is available for the treatment of postpartum haemorrhage due to uterine atony after vaginal birth.
Context specific recommendation
Only in specific contexts
Notes and Remarks
- Bimanual uterine compression is a simple, immediate, low-technology intervention that can be used by trained health personnel at all levels of the health system, including in settings with limited resources. This manoeuvre involves placing one hand inside the vagina to elevate and compress the uterus against the posterior wall of the abdomen, while the other hand applies firm pressure externally on the fundus. The goal is to mechanically compress the uterus to promote contraction and reduce bleeding.
- It is intended as a temporizing measure, not a definitive treatment, to stabilize the woman while preparing or arranging for additional interventions, such as uterotonics, balloon tamponade or surgical interventions.
- The GDG noted that the application of this intervention requires training in the proper technique and regular emergency drills to improve the correct and timely use of bimanual uterine compression in clinical practice.
- The procedure can be physically demanding for the health care provider and uncomfortable for the woman; complications associated with this procedure have been reported. Therefore, effective communication and use of pain relief, when feasible, are important. A less invasive, new device that could replicate bimanual compression is awaiting further evaluation