WHO recommendations for the prevention and treatment of postpartum haemorrhage

WHO recommendations for the prevention and treatment of postpartum haemorrhage

June 2017

 

Publication date: 2012

Background

Postpartum Haemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth. PPH is the leading cause of maternal mortality in low-income countries and the primary cause of nearly one quarter of all maternal deaths globally. Most deaths resulting from PPH occur during the first 24 hours after birth: the majority of these could be avoided through the use of prophylactic uterotonics during the third stage of labour and by timely and appropriate management. Improving health care for women during childbirth in order to prevent and treat PPH is an essential step towards the achievement of the Millennium Development Goals. The primary objective of these recommendations therefore is to provide a foundation for the strategic policy and programme development needed to ensure the sustainable implementation of effective interventions for reducing the global burden of PPH.  

Health professionals responsible for developing national and local protocols and health policies constitute the main target audience of these recommendations. Obstetricians, midwives, general medical practitioners, health care managers and public health policy-makers, particularly in under-resourced settings are also targeted. The guidance provided is evidence-informed and covers topics related to the management of PPH that were selected and prioritized by an international, multidisciplinary group of health care workers, consumers and other stakeholders.These recommendations establish general principles of  PPH and they are intended to inform the development of protocols and health policies related to PPH. These recommednations are not intended to provide a comprehensive practical guide for the prevention and treatment of PPH.

 

WHO Recommendations on PPH prevention

WHO recommendations on the use of uterotonics for the prevention of postpartum haemorrhage during the third stage of labor

WHO recommendations on cord management and uterine massage for the prevention of postpartum haemorrhage

WHO recommendations on prevention of postpartum haemorrhage in caesarean section

 

WHO Recommendations on PPH treatment

WHO recommendations on the use of uterotonics for the treatment of postpartum haemorrhage

WHO recommendation on the use of fluid replacement for the treatment of postpartum haemorrhage 

 WHO recommendation on the use of tranexamic acid for the treatment of postpartum haemorrhage

WHO recommendations on the use of manoeuvres and other procedures for the treatment of postpartum haemorrhage

WHO recommendations for the treatment of retained placenta

 

WHO recommendations on health systems and organization of care for the prevention and treatment of PPH

 

Topics for which there is insufficient evidence to issue a recommendation

There is insufficient evidence to recommend one oxytocin route over another for the prevention of PPH.

There is insufficient evidence to recommend the use of recombinant factor VIIa for the treatment of PPH.

There is insufficient evidence to recommend the use of intraumbilical vein injection of oxytocin as a treatment for retained placenta.

There is insufficient evidence to recommend the antenatal distribution of misoprostol to pregnant women for self-administration for the prevention of PPH.

There is insufficient evidence to recommend the measurement of blood loss over clinical estimation of blood loss.