# Objective measurement of postpartum blood loss Intervention · id `maternal:objective-blood-loss-measurement` · Maternal & Newborn Atlas · release `15708f235d73cd42` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Also called: Objective blood-loss measurement Browse, life stage: Childbirth; Postpartum ## In plain language Measuring the blood a woman loses after birth with a tool, instead of judging it by eye. WHO recommends doing this for every woman giving birth, and uses measured amounts in its criteria for deciding when to start treatment. ## Technical summary WHO 2025 Recommendation 21 (Revalidated, Recommended) recommends routine objective measurement for all women giving birth; calibrated drapes at vaginal birth are named as one method. Recommendation 22 (New, Recommended) gives the diagnostic criteria built on measured loss: 300 mL or more with any abnormal haemodynamic sign, or 500 mL or more, whichever occurs first within 24 hours after birth. WHO says measurement is effective only when linked to a standardized treatment protocol. ## Claims, with the population each applies to ## Context: All women giving birth, blood-loss measurement and diagnostic criteria for the first 24 hours (WHO 2025 Recommendations 21 and 22) Recipient: Maternal; Population: All women giving birth. Recommendation 21 covers routine objective measurement. Recommendation 22 applies its criteria within 24 hours after birth, with particular vigilance in the first 2 hours. WHO says the available studies were in women giving birth vaginally and that the criteria have some limitations for caesarean section.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first 24 hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context). The diagnostic criteria apply within 24 hours after birth. ### WHO 2025 recommends routine objective measurement of blood loss after birth for all women giving birth, to improve the detection and prompt treatment of postpartum haemorrhage (Recommendation 21, category Recommended, Revalidated from the 2023 recommendation). WHO names calibrated drapes for women having vaginal birth as one method. The recommendation is for measuring blood loss, not for a particular product. WHO adds that measurement works only when it is linked with a standardized treatment approach. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: All women giving birth. Recommendation 21 covers routine objective measurement. Recommendation 22 applies its criteria within 24 hours after birth, with particular vigilance in the first 2 hours. WHO says the available studies were in women giving birth vaginally and that the criteria have some limitations for caesarean section.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first 24 hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context). The diagnostic criteria apply within 24 hours after birth. - Limitations: Most of the available evidence is from vaginal birth; WHO says measurement at caesarean birth is also clinically important. WHO says current evidence does not support the diagnostic accuracy of alternatives such as blood collection trays and jars. The evidence tables (Web Annex A, Section 4.1) were not read. The wording is identical to Recommendation 1 of the 2023 document, which WHO integrated unchanged. WHO 2025 labels each recommendation with one of four categories and a development status. These are not GRADE strength labels, so the claim certainty is left not assessed. - Last checked: 2026-10-11 - Sources: 1. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 21: recommendation text and category. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 2. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 21, Remarks: objective methods, drape evidence, link to treatment protocol, alternatives. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 3. Background: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Summary list of recommendations, footnote to Recommendation 21: integrated from the 2023 recommendations. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 4. Background: WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum haemorrhage (Guideline, edition 2023. History and burden figures only: WHO integrated Recommendations 1 and 2 of this document into its 2025 consolidated guideline unchanged, as Recommendations 21 and 29, so the 2025 document carries the current decisions.) Locator: Table 1, Recommendation 1: the same wording in 2023. Retrieved 2026-10-11T19:12:01Z. Source state: Current. Snapshot hash: 36364aa61f4e3b6dc00561e5a5d6aff380639230952bda6cab1db58d81c66ad8. How it applies: WHO 2023 recommendations, CC BY-NC-SA 3.0 IGO; history only. ### WHO 2025 recommends these criteria to identify women at risk of adverse outcomes from bleeding after birth and to start first-response treatment (Recommendation 22, new, category Recommended). Objectively measured blood loss of 300 mL or more together with any abnormal sign (pulse above 100 beats a minute, shock index above 1, systolic blood pressure below 100 mmHg, or diastolic blood pressure below 60 mmHg), or objectively measured blood loss of 500 mL or more, whichever occurs first within 24 hours after birth, with particular vigilance during the first 2 hours. WHO calls this a "therapeutic definition", a threshold meant to guide when to start treatment rather than to classify the condition. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: All women giving birth. Recommendation 21 covers routine objective measurement. Recommendation 22 applies its criteria within 24 hours after birth, with particular vigilance in the first 2 hours. WHO says the available studies were in women giving birth vaginally and that the criteria have some limitations for caesarean section.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first 24 hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context). The diagnostic criteria apply within 24 hours after birth. - Limitations: WHO describes the supporting evidence as moderate-certainty, from an individual-participant meta-analysis of over 300 000 women in 12 datasets across 23 countries, with some limitations for caesarean section. The certainty here stays not assessed because the GRADE profile for this exact statement was not read. The evidence annex was not read. The definition differs from the WOMAN eligibility wording and from the older rule of thumb of more than 500 mL. WHO 2025 labels each recommendation with one of four categories and a development status. These are not GRADE strength labels, so the claim certainty is left not assessed. - Last checked: 2026-10-11 - Sources: 1. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 22: criteria text and category. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 2. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 22, Remarks, bullet 1: therapeutic definition. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 3. Background: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 22, Justification: evidence base and caesarean limitation. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. ## Guidance, authorization and access ### Recommendation `maternal:rec-who-2025-pph-21` - Intervention: Objective measurement of postpartum blood loss (`maternal:objective-blood-loss-measurement`) - Direction: Recommended - Issued by: World Health Organization (`maternal:who`) - Guideline: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.; snapshot `maternal:who-9789240115637-pdf-2026-10-11` - Jurisdiction: Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM. - Strength: Recommended (WHO 2025 consolidated PPH guideline. Each recommendation falls in one of four categories (Recommended, Not recommended, Recommended only in specific contexts, Recommended only in the context of rigorous research) and carries a development status (New, Updated, Revalidated or Edited). These are not GRADE strength labels. Recommendation 21 is Revalidated.) - Effective: 2025-10-05 (The who.int page date, 5 October 2025 (2025-10-05), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2025-09-26. Both dates are kept.) - Applies to: Recipient: Maternal; Population: All women giving birth. Recommendation 21 covers routine objective measurement. Recommendation 22 applies its criteria within 24 hours after birth, with particular vigilance in the first 2 hours. WHO says the available studies were in women giving birth vaginally and that the criteria have some limitations for caesarean section.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first 24 hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context). The diagnostic criteria apply within 24 hours after birth. - Basis: claim `maternal:claim-who-2025-pph-21-objective-measurement` ### Recommendation `maternal:rec-who-2025-pph-22` - Intervention: Objective measurement of postpartum blood loss (`maternal:objective-blood-loss-measurement`) - Direction: Recommended - Issued by: World Health Organization (`maternal:who`) - Guideline: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.; snapshot `maternal:who-9789240115637-pdf-2026-10-11` - Jurisdiction: Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM. - Strength: Recommended (WHO 2025 consolidated PPH guideline. Each recommendation falls in one of four categories (Recommended, Not recommended, Recommended only in specific contexts, Recommended only in the context of rigorous research) and carries a development status (New, Updated, Revalidated or Edited). These are not GRADE strength labels. Recommendation 22 is New.) - Effective: 2025-10-05 (The who.int page date, 5 October 2025 (2025-10-05), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2025-09-26. Both dates are kept.) - Applies to: Recipient: Maternal; Population: All women giving birth. Recommendation 21 covers routine objective measurement. Recommendation 22 applies its criteria within 24 hours after birth, with particular vigilance in the first 2 hours. WHO says the available studies were in women giving birth vaginally and that the criteria have some limitations for caesarean section.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first 24 hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context). The diagnostic criteria apply within 24 hours after birth. - Basis: claim `maternal:claim-who-2025-pph-22-diagnostic-criteria` ## Connected pages - Calibrated drapes are the named method for vaginal birth: Calibrated blood-collection drape (`maternal:calibrated-blood-collection-drape`) - WHO 2025 Recommendation 21: recommended for all women giving birth: Postpartum haemorrhage (`maternal:postpartum-hemorrhage`) [a claim, not a settled fact; see claim `maternal:claim-who-2025-pph-21-objective-measurement` and its context] - Required by: PPH detection and first-response treatment bundle (`maternal:pph-detection-and-first-response-bundle`) ## Provenance Content hash: bbe9f4107ca5cb63926d82e90e56a1f72f3fe63d28a5e4126835c871b2f6e052 Last substantive edit: 2026-10-11 Evidence last checked: 2026-10-11