# PPH detection and first-response treatment bundle Intervention · id `maternal:pph-detection-and-first-response-bundle` · 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: E-MOTIVE package; MOTIVE bundle Browse, life stage: Childbirth; Postpartum ## In plain language A package for hospitals. Staff measure blood loss at vaginal births with a calibrated drape, and when heavy bleeding is detected they start a standard set of treatments straight away. The set covers uterine massage, a uterus-contracting medicine, tranexamic acid, fluids into a vein, a check for the source of bleeding and calling for more help. Staff training and feedback support the package. ## Technical summary The package combines objective blood-loss assessment with a calibrated drape, a first-response bundle (uterine massage, an oxytocic drug, tranexamic acid, intravenous fluids, examination of the genital tract and escalation of care) and an implementation strategy. WHO 2025 Recommendation 29 (Revalidated, Recommended) recommends it for all women having a vaginal birth. E-MOTIVE tested the whole package; the drape alone was not tested, and the effect cannot be assigned to any component. WHO says the supporting evidence comes largely from vaginal births in secondary-level facilities and that more research is needed before recommending bundle care at caesarean birth. ## Claims, with the population each applies to ## Context: Patients having vaginal delivery in 80 secondary-level hospitals in Kenya, Nigeria, South Africa and Tanzania (E-MOTIVE) Recipient: Maternal; Population: Patients having a vaginal delivery in the study hospitals. Hospitals were randomly assigned to the package or to usual care. The abstract reports results among hospitals and patients with data, not for all randomised deliveries. The registry describes its research participants as health care providers attending vaginal births, a different basis from the paper.; Care setting: Secondary-level hospitals.; Geography: Kenya, Nigeria, South Africa and Tanzania.; Life stage: Childbirth and the first hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the abstract. ### E-MOTIVE tested a package, not a single product. The package was a calibrated blood-collection drape for early detection, a bundle of first-response treatments, and a strategy to help hospitals use them. 80 secondary-level hospitals in Kenya, Nigeria, South Africa and Tanzania were randomly assigned to the package or to usual care. "Among hospitals and patients with data", severe bleeding (1000 mL or more), laparotomy for bleeding or death from bleeding occurred in 1.6% of patients with the package and 4.3% with usual care (risk ratio 0.40, 95% CI 0.32 to 0.50). Postpartum haemorrhage was detected in 93.1% against 51.1% (rate ratio 1.58, 1.41 to 1.76), and the bundle was used in 91.2% against 19.4% (rate ratio 4.94, 3.88 to 6.28). - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: Patients having a vaginal delivery in the study hospitals. Hospitals were randomly assigned to the package or to usual care. The abstract reports results among hospitals and patients with data, not for all randomised deliveries. The registry describes its research participants as health care providers attending vaginal births, a different basis from the paper.; Care setting: Secondary-level hospitals.; Geography: Kenya, Nigeria, South Africa and Tanzania.; Life stage: Childbirth and the first hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the abstract. - Limitations: The effect belongs to the whole package (drape, bundle and implementation strategy) and cannot be split by component, so none of it is credited to the drape or to tranexamic acid alone. Randomisation was by hospital. Only the NEJM abstract was read, because the full text returned HTTP 403 and was not retrieved another way, so analysis methods are not described. The percentages are results among hospitals and patients with data and are not counts of individual patients. The registry gives 99659 enrolled (actual), describes the research participants as health care providers attending vaginal births, and lists no masking; the paper reports 210,132 vaginal deliveries. These are different bases and are not reconciled. The primary outcome is a composite, so the abstract gives no separate effect on maternal death. - Last checked: 2026-10-11 - Sources: 1. Supports: Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage (Publication, edition Abstract only, from PubMed (PMID 37158447). The version of record returned HTTP 403 on 2026-10-11 and was not retrieved by any other route. No PMC full text exists, so the analysis methods are not described in any record.) Locator: Abstract, METHODS: package and cluster design. Retrieved 2026-10-11T19:11:01Z. Source state: Current. Snapshot hash: ac7a6b8ccd74b1e8eec860852401c1052be14e9cbe32a7f923b2be380a8662d0. How it applies: PubMed abstract; the full text was not retrieved. 2. Supports: Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage (Publication, edition Abstract only, from PubMed (PMID 37158447). The version of record returned HTTP 403 on 2026-10-11 and was not retrieved by any other route. No PMC full text exists, so the analysis methods are not described in any record.) Locator: Abstract, RESULTS: primary outcome, detection and bundle use. Retrieved 2026-10-11T19:11:01Z. Source state: Current. Snapshot hash: ac7a6b8ccd74b1e8eec860852401c1052be14e9cbe32a7f923b2be380a8662d0. How it applies: PubMed abstract; results among hospitals and patients with data. 3. Background: A Clinical Trial to Study the Effectiveness of a Care Bundle to Prevent Bleeding After a Woman Has Given Birth (Registry, edition API v2 JSON, fetched on 2026-10-11. The record has posted results, which were not read.) Locator: protocolSection.designModule: enrollment count and masking. Retrieved 2026-10-11T19:11:02Z. Source state: Current. Snapshot hash: 0a7a1ede0bc051836032b9f2016627544ebe5a0c0093f178b25e94a4ab1a6a8f. How it applies: Registry JSON; a different basis from the paper. 4. Background: A Clinical Trial to Study the Effectiveness of a Care Bundle to Prevent Bleeding After a Woman Has Given Birth (Registry, edition API v2 JSON, fetched on 2026-10-11. The record has posted results, which were not read.) Locator: protocolSection.descriptionModule.detailedDescription: research participants. Retrieved 2026-10-11T19:11:02Z. Source state: Current. Snapshot hash: 0a7a1ede0bc051836032b9f2016627544ebe5a0c0093f178b25e94a4ab1a6a8f. How it applies: Registry wording on who the participants are. ## Context: Women having a vaginal birth, objective assessment with a first-response bundle (WHO 2025 Recommendation 29) Recipient: Maternal; Population: All women having a vaginal birth. WHO says the supporting evidence comes largely from vaginal births in secondary-level facilities and that more research is needed to recommend bundle care at caesarean birth.; Care setting: Health facilities. The evidence is largely from secondary-level facilities; WHO says recognition and treatment are equally relevant in primary care, community and home settings.; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) ### WHO 2025 recommends a standardized and timely approach to managing postpartum haemorrhage for all women having a vaginal birth (Recommendation 29, category Recommended, Revalidated from the 2023 recommendation). The approach combines an objective assessment of blood loss with a treatment bundle supported by an implementation strategy. The first-line bundle includes rapid uterine massage, an oxytocic medicine and tranexamic acid, intravenous fluids, examination of the genital tract and escalation of care. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: All women having a vaginal birth. WHO says the supporting evidence comes largely from vaginal births in secondary-level facilities and that more research is needed to recommend bundle care at caesarean birth.; Care setting: Health facilities. The evidence is largely from secondary-level facilities; WHO says recognition and treatment are equally relevant in primary care, community and home settings.; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) - Limitations: The supporting evidence is largely from vaginal births in secondary-level facilities; WHO says more research is needed before recommending bundle care at caesarean birth, although each treatment is separately recommended. The trial behind this recommendation included multiple implementation and health system strengthening strategies, so the recommended package is more than the drape and the medicines. WHO says its evidence on measuring blood loss comes largely from trials using calibrated drapes. 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 29: 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 29, Remarks: implementation strategies, drape evidence, caesarean research need. 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 29: 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 2: the same recommendation 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. ## Guidance, authorization and access ### Recommendation `maternal:rec-who-2025-pph-29` - Intervention: PPH detection and first-response treatment bundle (`maternal:pph-detection-and-first-response-bundle`) - 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 29 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 having a vaginal birth. WHO says the supporting evidence comes largely from vaginal births in secondary-level facilities and that more research is needed to recommend bundle care at caesarean birth.; Care setting: Health facilities. The evidence is largely from secondary-level facilities; WHO says recognition and treatment are equally relevant in primary care, community and home settings.; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth and the first hours after birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) - Basis: claim `maternal:claim-who-2025-pph-29-bundle` ## Connected pages - Uses a calibrated drape for early detection: Calibrated blood-collection drape (`maternal:calibrated-blood-collection-drape`) - Detection depends on measured blood loss: Objective measurement of postpartum blood loss (`maternal:objective-blood-loss-measurement`) - Tranexamic acid is one part of the treatment bundle: Tranexamic acid for treating postpartum haemorrhage (`maternal:tranexamic-acid-pph-treatment`) - WHO 2025 Recommendation 29: recommended for vaginal birth: Postpartum haemorrhage (`maternal:postpartum-hemorrhage`) [a claim, not a settled fact; see claim `maternal:claim-who-2025-pph-29-bundle` and its context] - Evaluated as a package in E-MOTIVE: Postpartum haemorrhage (`maternal:postpartum-hemorrhage`) [a claim, not a settled fact; see claim `maternal:claim-emotive-detection` and its context] ## Provenance Content hash: b1ec619c447dd7ca865e7aecb03b1a7e551c7e7274102d14204b59e9ede6c2d3 Last substantive edit: 2026-10-11 Evidence last checked: 2026-10-11