Assessment of postpartum blood loss• Visual estimation of postpartum blood loss is frequently inaccurate, meaning that PPH often goes unrecognized or is identified when it is too late to provide a life-saving intervention. Objective methods of quantifying blood loss, which are superior to visual estimation, are more likely to detect PPH. For women who have had a vaginal birth, most of the available evidence on postpartum blood loss measurement comes from the use of a calibrated drape.

• Blood loss measurement is particularly critical in the first few hours after birth. Women should also be regularly monitored for early warning signs of excessive blood loss (e.g. tachycardia or hypotension).
• To be effective, measurement of postpartum blood loss must be linked with a standardized treatment approach or protocol, and vice versa. Detecting PPH, in the absence of prompt initiation of treatment, is unlikely to improve a woman’s health outcomes.
• The available studies have been conducted in women giving birth vaginally. However, the measurement of blood loss in women undergoing a caesarean section is also clinically important.
• The process for postpartum blood loss measurement should ensure that a woman’s customary or cultural requirements, including choice of birth position, are respected and maintained.
• Birth-related bleeding risks and the signs and symptoms of excessive blood loss should be discussed with women across the birth continuum (including antenatally) to foster shared decision-making.
• There should be consideration and investments made into the development and use of sustainable and climate-friendly drapes. Care bundle for the treatment of PPH
• All interventions included within the PPH treatment bundle are individually recommended in the existing 2012 and 2017 WHO PPH guidelines. Visual estimation of postpartum blood loss is frequently inaccurate, meaning that PPH often goes unrecognized or is identified when it is too late to provide a life-saving intervention. Objective methods of quantifying blood loss, which are superior to visual estimation, are more likely to detect PPH. For women who have had a vaginal birth, most of the available evidence on postpartum blood loss measurement comes from the use of a calibrated drape.
• Blood loss measurement is particularly critical in the first few hours after birth. Women should also be regularly monitored for early warning signs of excessive blood loss (e.g. tachycardia or hypotension).
• To be effective, measurement of postpartum blood loss must be linked with a standardized treatment approach or protocol, and vice versa. Detecting PPH, in the absence of prompt initiation of treatment, is unlikely to improve a woman’s health outcomes.
• The available studies have been conducted in women giving birth vaginally. However, the measurement of blood loss in women undergoing a caesarean section is also clinically important.
• The process for postpartum blood loss measurement should ensure that a woman’s customary or cultural requirements, including choice of birth position, are respected and maintained.
• Birth-related bleeding risks and the signs and symptoms of excessive blood loss should be discussed with women across the birth continuum (including antenatally) to foster shared decision-making.
• The GDG acknowledged that alternatives to calibrated drapes, such as blood collection trays and jars, are increasingly being promoted in some settings for measuring postpartum blood loss. However, current evidence does not support the diagnostic accuracy of these alternatives. By contrast, calibrated blood collection drapes have been shown to provide more accurate quantification of postpartum blood loss compared to visual estimation (54). Countries or programmes considering the scale-up of postpartum blood loss measurement should ensure that any chosen device is evidence-based and fit for purpose, so that the intended impact of timely PPH detection and treatment is not undermined by the use of less reliable tools.
• There should be consideration and investments made into the development and use of sustainable and climate-friendly drapes.