FIGO Member Societies Unite to Reduce Postpartum Hemorrhage and Save Mothers Lives
A mother can survive childbirth and still be lost within hours if postpartum haemorrhage is not recognised and treated fast enough. That is the urgency behind one of the most preventable causes of maternal death worldwide.
Postpartum haemorrhage, often called PPH, is severe bleeding after birth. It is commonly defined as blood loss of 500 ml or more after vaginal birth, 1,000 ml or more after caesarean birth, or any blood loss that causes signs of shock. The danger is not only the volume of blood. It is the speed at which a stable postpartum patient can become critically ill.
The World Health Organization estimates that postpartum haemorrhage affects about 14 million women every year. It causes around 70,000 maternal deaths annually, most of them in low-resource settings. Globally, haemorrhage accounts for roughly one quarter of maternal deaths, making it one of the leading direct causes of maternal mortality.
These numbers are not inevitable. FIGO member societies are uniquely placed to change them.
As national obstetrics and gynaecology societies, FIGO members connect clinical expertise, health system leadership, policy influence, training networks, and frontline realities. When they work together, they can turn proven guidance into routine practice, not just in tertiary hospitals, but across district hospitals, maternity centres, and community-linked systems.
This is why ADDRESSING POSTPARTUM HEMORRHAGE must remain a shared priority for every FIGO member society.
Postpartum haemorrhage is a systems problem, not only a clinical emergency
PPH is often treated as a sudden emergency, and it is. Yet the conditions that determine survival are usually built long before the bleeding starts.
A safe response depends on:
Accurate risk assessment during pregnancy and labour
Skilled birth attendance
Ready access to uterotonics
Reliable blood loss measurement
Rapid escalation protocols
Blood transfusion services
Referral pathways that work at night, at weekends, and in remote areas
Teams trained to act without delay
A patient may bleed in minutes, but the response reflects months or years of preparation. This is where FIGO member societies can have major impact. They can help countries move from individual heroics to standardised, team-based care.
The burden is not evenly shared. Maternal deaths from haemorrhage are far more common where health facilities lack blood products, medicines, transport, trained staff, or clear protocols. Anaemia, which remains common in many regions, including South Asia and sub-Saharan Africa, increases the danger because even moderate blood loss can become life-threatening.
PPH also harms survivors. Severe bleeding can lead to shock, organ injury, emergency hysterectomy, prolonged hospitalisation, loss of fertility, trauma, depression, and long-term financial hardship for families. A death or near-miss after childbirth affects newborn health, older children, households, and communities.
Reducing PPH is not only a maternal health goal. It is a health system quality goal.
FIGO member societies can turn global guidance into local practice
Global recommendations only save lives when they fit local contexts. FIGO member societies understand national practice patterns, regulatory systems, training gaps, medicine availability, and referral networks. This makes them essential translators of evidence into practice.
Their role can include:
Updating national clinical guidelines
Training obstetricians, midwives, anaesthetists, nurses, and emergency teams
Supporting maternal death surveillance and response
Advising ministries of health on safe medicines and procurement
Developing audit tools and simulation programmes
Promoting respectful, rights-based maternity care
Encouraging research that reflects local needs
The most effective societies do not stop at publishing a guideline. They help facilities test it, teach it, measure it, and improve it.
For example, a national society may recommend oxytocin for prevention of PPH. But the real question is whether oxytocin is stored correctly, available in every labour room, given at the right dose and time, and documented reliably. A guideline becomes lifesaving only when these steps happen consistently.
Core practices that reduce deaths from postpartum haemorrhage
No single intervention will eliminate PPH. A strong response combines prevention, early detection, rapid treatment, and escalation.
Prevent bleeding with active management of the third stage of labour
Active management of the third stage of labour is one of the most established practices for reducing postpartum bleeding. It usually includes timely use of a uterotonic after birth, controlled cord traction where skilled staff are available, and assessment of uterine tone.
Oxytocin remains the first-line uterotonic for prevention in many guidelines, commonly given as 10 IU intramuscularly or intravenously after birth, depending on national protocols. It is effective, familiar, and widely used.
Where oxytocin quality or cold-chain storage is unreliable, other uterotonics may have a role. Misoprostol can be useful in settings where injectable uterotonics are not available. Heat-stable carbetocin may be considered in some settings, based on cost, availability, and national approval.
The key is not only which medicine a guideline names. The key is whether every birth setting has a realistic plan for safe uterotonic use.
Measure blood loss instead of estimating it
Visual estimation of blood loss is often inaccurate. Teams tend to underestimate bleeding, especially when blood is absorbed into linen, mixed with amniotic fluid, or spread across the floor.
Quantified blood loss can improve recognition. This may include calibrated drapes, weighing soaked materials, using collection containers, and documenting cumulative blood loss after birth.
A simple shift from “she looks like she is bleeding” to “she has lost 700 ml and her pulse is rising” can trigger faster action.
FIGO member societies can promote practical measurement tools that work in both high-resource and low-resource settings. Expensive devices are not always necessary. Consistent practice matters more.
Treat early with a multidisciplinary bundle
PPH treatment works best when teams act in parallel, not in sequence. A delay of even 10 to 15 minutes can matter.
A practical first-response bundle often includes:
Call for help immediately
Assess airway, breathing, circulation, pulse, blood pressure, and mental status
Massage the uterus if atony is suspected
Give uterotonic treatment according to protocol
Start intravenous access and fluids
Send blood samples for haemoglobin, clotting, and crossmatch where available
Identify the cause using the “4 Ts”
Give tranexamic acid as early as possible when PPH is diagnosed
Prepare blood products and escalate if bleeding continues
The “4 Ts” remain a useful clinical memory aid:
Cause | What to check |
Tone | Uterine atony, the most common cause of PPH |
Trauma | Tears, uterine rupture, surgical bleeding |
Tissue | Retained placenta or retained products |
Thrombin | Coagulation problems |
Tranexamic acid has become a major tool in PPH care. WHO recommends early intravenous tranexamic acid within 3 hours of birth for clinically diagnosed PPH, alongside standard care. It is not a replacement for uterotonics, surgery, or transfusion when needed. It is part of a timely package.
Escalate before the patient crashes
Many deaths occur because escalation comes too late. Bleeding may continue while teams repeat basic measures, wait for senior help, or delay transfer.
Facilities need clear thresholds for action. For example:
When to activate a PPH emergency call
When to request blood
When to move to theatre
When to use uterine balloon tamponade
When to transfer to a higher-level facility
When to consider surgical measures such as compression sutures, arterial ligation, or hysterectomy
Uterine balloon tamponade can be lifesaving for atonic PPH when bleeding does not respond to uterotonics and massage, especially as a bridge to definitive care. Surgical options also remain essential where conservative measures fail.
Member societies can help define escalation pathways that reflect available resources. A district hospital without round-the-clock blood bank access needs a different transfer protocol from a tertiary centre. Both need clarity.
Why collaboration among FIGO member societies matters
Nearly every country has lessons to share. Some have improved access to uterotonics in rural care. Some have built strong simulation programmes. Some have reduced delays through emergency transport systems. Others have improved maternal death review, blood bank coordination, or PPH bundles.
FIGO member societies can accelerate progress by sharing what works.
This collaboration should be practical and continuous, not limited to conference presentations. Societies can build regional learning networks where teams compare protocols, discuss implementation barriers, and adapt tools for different settings.
Useful areas for shared work include:
Standardised PPH training packages
Low-cost simulation drills
Audit forms for severe maternal morbidity
Checklists for labour rooms
Guidance on oxytocin storage and quality
Models for blood availability in lower-level facilities
Mentorship between high-volume centres and smaller facilities
Research on culturally and geographically specific barriers to care
A successful strategy in one country cannot always be copied exactly. But it can be adapted. That is why collaboration matters. It helps societies avoid repeating mistakes and shortens the time between evidence and action.
Data must guide the response
PPH reduction needs measurement. Without data, facilities may not know whether cases are rising, treatment is delayed, or deaths are linked to the same preventable gaps.
FIGO member societies can advocate for stronger maternal death surveillance and response systems, including respectful review of near-miss cases. The goal is not blame. The goal is learning.
Key indicators may include:
Number of PPH cases per births
Severe PPH cases requiring transfusion or surgery
Time from diagnosis to first uterotonic
Time from diagnosis to tranexamic acid
Time to blood transfusion when indicated
Maternal deaths linked to haemorrhage
Availability of uterotonics and PPH kits
Staff participation in emergency drills
Data should be simple enough for busy facilities to collect and meaningful enough to change practice. A monthly review of three delayed PPH responses may save more lives than a complex report no one uses.
Training must include the whole team
PPH care is team care. Obstetricians matter, but they cannot carry the response alone. Midwives, nurses, anaesthetists, laboratory teams, blood bank staff, ambulance services, and hospital leadership all shape outcomes.
Simulation training can help teams practise rare but high-risk moments. A drill can reveal practical problems that a written protocol misses. For example, teams may discover that the PPH kit is locked away, the emergency bell cannot be heard, blood forms are confusing, or no one knows who calls the operating theatre.
Good training builds reflexes:
One person leads
One person records time and treatments
One person gives uterotonics
One person secures intravenous access
One person communicates with blood bank and theatre
One person supports the patient and family
Respectful communication also matters. Even in emergencies, patients deserve clear explanations, privacy, consent where possible, and compassionate care. Saving a life and preserving dignity must go together.
Policy, procurement, and supply chains are part of clinical care
A clinician cannot give a medicine that is out of stock. A team cannot transfuse blood that is unavailable. A facility cannot follow a protocol if essential tools are missing.
FIGO member societies can use their authority to advocate for reliable supplies and safer systems. This includes quality-assured uterotonics, tranexamic acid, IV fluids, blood collection and transfusion supplies, calibrated drapes, uterine balloon tamponade devices where appropriate, and functioning referral transport.
Oxytocin storage deserves special attention. It usually requires cold-chain conditions to maintain potency. If storage fails, a medicine may be present but less effective. Member societies can push for audits of storage conditions and support national discussions on suitable uterotonic choices for different levels of care.
Policy work may feel distant from bedside care, but it decides what is available when bleeding starts.
A shared agenda for FIGO member societies
The path forward is clear. Every member society can contribute, whatever its size or resources.
A shared FIGO-aligned agenda could include five commitments.
Make PPH prevention routine
Every birth should include evidence-based prevention, reliable uterotonic use, and early postpartum monitoring.
Recognise bleeding early
Facilities should move from guesswork to measured blood loss wherever possible.
Treat without delay
Protocols should support rapid uterotonics, tranexamic acid, resuscitation, cause identification, and escalation.
Review every severe case
Maternal death and near-miss reviews should lead to changes in training, supplies, referral, or staffing.
Share what works
Member societies should exchange tools, data, and lessons across countries and regions.
This agenda is ambitious, but it is not unrealistic. Many interventions are known. The challenge is making them dependable.
The call to act is urgent
Postpartum haemorrhage is frightening because it moves quickly. It is also hopeful because so many deaths can be prevented with preparation, teamwork, and timely care.
FIGO member societies stand at a powerful junction. They can influence clinicians, health systems, ministries, training institutions, and public awareness. They can help ensure that every maternity unit, from a rural facility to a national referral centre, has the knowledge, supplies, and confidence to respond.
The work ahead demands more than guidelines on paper. It calls for shared standards, local adaptation, honest review, and open exchange of successful strategies. When member societies learn from one another, they multiply progress.
A safer birth is possible when bleeding is expected, recognised, and treated as an emergency from the first signs. The measure of success is simple and profound: more mothers surviving childbirth, recovering with dignity, and returning home to their families.
This article is for general information and awareness. Clinical care should follow current national guidelines and the judgement of qualified health professionals.
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