The World Health Organization (WHO) is committed to driving public health impact in every country, ensuring healthy lives and promoting well-being for all at all ages.  Through its unique normative function in health, WHO aims to provide global, evidence-informed recommendations to improve maternal and perinatal health. 

Obstetric haemorrhage is the leading cause of maternal mortality, accounting for 27% of all maternal deaths occurring worldwide each year. The majority of these deaths are due to postpartum haemorrhage (PPH). The WHO estimates that about 14 million women experience PPH each year.

Steps towards reducing the incidence and impact of PPH would significantly contribute to reducing maternal mortality and morbidity. Likewise, an improvement in the overall quality of maternal health care to prevent and treat complications such as PPH is critical to attaining the Sustainable Development Goals (SDGs) health targets.

Guidelines are needed to provide optimal, evidence-based care to women experiencing PPH.  

Approaches to assessment of postpartum blood loss

Accurate blood loss measurement is critical to ensure timely recognition of PPH and initiation of potentially life-saving interventions. Traditional methods for blood loss estimation have relied primarily on visual estimation, during which the birth attendant makes a quantitative or semi‐quantitative estimate of the amount of blood lost. In recent years, advanced methods for precise measurements have been developed but these can be difficult to perform and are not accessible in most settings.

In 2012, WHO’s guideline on the prevention and treatment of PPH did not make a specific recommendation on blood loss assessment during the third stage of labour, stating that “There is insufficient evidence to recommend the measurement of blood loss over clinical estimation of blood loss.” There is therefore great need for this clinical question and evidence base to be revisited. 

Use of care bundles for PPH

Care bundles are a type of complex intervention that comprise a straightforward set of evidence-based practices that, when performed collectively and reliably, can improve patient outcomes. Care bundles have been implemented in some areas of maternity care including surveillance for fetal growth restriction and preterm birth management, with associated improvements in process-of-care and health outcomes.

The use of a care bundle for PPH treatment is conceptually linked to the accurate assessment of blood loss to detect PPH – the earlier that PPH can be identified and diagnosed, the more rapidly that a care bundle can be initiated. WHO has not previously issued any prior recommendation on a care bundle for the treatment of PPH. Hence, this will constitute a new recommendation.

WHO is convening the first meeting of this WHO guideline development group – subgroup: PPH Bundles on 31 Aug-1 Sep 2023  (12:00-15:00h CET each day).  The objectives of this meeting are to:

• Review the evidence about approaches for blood loss assessment for the detection of PPH and the use of care bundles for the treatment of PPH.
• Discuss and agree on recommendations on the approaches to blood loss assessment for the detection of PPH and the use of care bundles for the treatment of PPH.