Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Postpartum abdominal uterine tonus assessment for early identification of uterine atony is recommended for all women
Recommended
Notes and Remarks
- This recommendation emphasizes the importance of early detection of uterine atony, which is the most common cause of PPH. Immediately after the birth of the baby or babies and placenta, regular abdominal palpation to assess uterine firmness and ensure that the fundus is well contracted and centrally located should be initiated. The first hour after birth is particularly important; close regular assessment during this time, ideally every 15 minutes, is essential. Continued assessments should follow local protocols but typically extend through the first 1–2 hours postpartum, with reduced frequency thereafter if no abnormalities are detected. Finding of a soft or boggy uterus at any time should prompt further examination and clinical response to prevent severe blood loss and clinical deterioration.
- The frequency and duration of assessment may be adapted based on clinical judgement, local protocols and individual risk factors.
- Although uterine massage is not recommended as a routine prophylactic intervention, it remains a first-line response in cases where uterine atony is identified during uterine tonus assessment. This distinction should be clearly understood in clinical practice.
- The implementation of this recommendation is especially critical in settings where quantitative blood loss measurement is not yet accessible because changes in uterine tone can be an early and important clinical marker of ongoing bleeding