{ "release_id": "15708f235d73cd42", "id": "maternal:bottleneck-pph-detection", "owner": "maternal", "kind": "bottleneck", "slug": "bottleneck-pph-detection", "name": "Late detection of postpartum haemorrhage", "aliases": [ "PPH detection gap" ], "atlases": [ "maternal" ], "summary_plain": "Heavy bleeding after birth is often missed or noticed late when blood loss is judged by eye, which is frequently inaccurate. The response WHO now recommends is to measure blood loss objectively and to start a standard set of treatments straight away.", "summary_technical": "WHO says visual estimation is frequently inaccurate, so PPH often goes unrecognised or is identified too late for a life-saving intervention. WHO also says life-saving interventions may be used inconsistently or deployed late because of delayed diagnosis. The two WHO burden figures (2023 and 2025) have different bases and stay separate. Current efforts listed here are an objective-measurement tool, a package that pairs measurement with treatment, and WHO itself as the issuer of the recommendations.", "editorial_state": "draft", "last_substantive_edit": "2026-10-11", "last_evidence_check": "2026-10-11", "next_review_due": null, "external_ids": [], "navigation": { "maternal": { "life-stage": [ "childbirth", "postpartum" ] } }, "payload": { "stage": "Detection and diagnosis in the first hours after birth", "scope": "Women giving birth, with the strongest evidence for vaginal birth in secondary-level facilities; the burden is concentrated in low- and middle-income countries.", "severity_rationale": "Delays in detection or treatment can result in complications or death (E-MOTIVE abstract); WHO says deaths from PPH are largely preventable but the interventions are used inconsistently or late.", "burden_claims": [ "maternal:claim-who-2023-burden", "maternal:claim-who-2025-burden" ], "current_efforts": [ "maternal:calibrated-blood-collection-drape", "maternal:pph-detection-and-first-response-bundle", "maternal:who" ] }, "content_digest": "0d8b0ea97ec21eda15280044ce9efab5c3e96ebfba0f98212c771fcc23bcf9b2", "review": { "content_digest": "0d8b0ea97ec21eda15280044ce9efab5c3e96ebfba0f98212c771fcc23bcf9b2", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "15708f235d73cd42", "id": "maternal:claim-who-2023-visual-estimation-inaccurate", "owner": "maternal", "subject_entity_id": "maternal:bottleneck-pph-detection", "category": "descriptive", "statement": "WHO says that visual estimation of blood loss after birth is frequently inaccurate, so postpartum haemorrhage often goes unrecognised or is identified too late to give a life-saving treatment. Objective methods of measuring blood loss are superior to visual estimation and more likely to detect PPH. The same remark is in WHO's 2023 recommendations and, unchanged, in the 2025 consolidated guideline under Recommendation 21.", "context": { "id": "maternal:ctx-who-2025-pph-all-women-giving-birth", "label": "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_min_days": null, "gestational_age_max_days": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context). The diagnostic criteria apply within 24 hours after birth.", "eligibility": { "inclusion": [ "Any woman giving birth, by vaginal birth or caesarean section" ], "exclusion": [] } }, "evidence_stage": "synthesis", "certainty": "not_assessed", "certainty_method": null, "limitations": "This is an expert remark attached to a recommendation, not a measured accuracy figure. The WHO text cites a reference for calibrated drapes that this record did not read. WHO also says life-saving interventions may be used inconsistently or deployed late because of delayed diagnosis.", "editorial_state": "draft", "checked_at": "2026-10-11", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Recommendation 21, Remarks, bullet 1: visual estimation frequently inaccurate", "applicability_note": "WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240115637-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:12:00Z", "content_hash": "2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2025-pph-consolidated", "source_type": "guideline", "title": "Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage", "canonical_url": "https://www.who.int/publications/i/item/9789240115637", "identifier_namespace": "isbn", "identifier_value": "978-92-4-011563-7", "publication_date": "2025-10-05", "publisher": "World Health Organization, co-published with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM)", "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.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF and in the IRIS record. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 1, Remarks, Assessment of postpartum blood loss: the same remark in 2023", "applicability_note": "WHO 2023 recommendations, CC BY-NC-SA 3.0 IGO.", "snapshot": { "id": "maternal:who-9789240085398-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:12:01Z", "content_hash": "36364aa61f4e3b6dc00561e5a5d6aff380639230952bda6cab1db58d81c66ad8", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2023-pph-bundle", "source_type": "guideline", "title": "WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum haemorrhage", "canonical_url": "https://www.who.int/publications/i/item/9789240085398", "identifier_namespace": "isbn", "identifier_value": "978-92-4-008539-8", "publication_date": "2023-12-21", "publisher": "World Health Organization", "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.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF and in the IRIS record. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Executive summary, Introduction, para 2: delayed diagnosis and late use of interventions", "applicability_note": "WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240115637-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:12:00Z", "content_hash": "2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2025-pph-consolidated", "source_type": "guideline", "title": "Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage", "canonical_url": "https://www.who.int/publications/i/item/9789240115637", "identifier_namespace": "isbn", "identifier_value": "978-92-4-011563-7", "publication_date": "2025-10-05", "publisher": "World Health Organization, co-published with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM)", "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.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF and in the IRIS record. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } } ], "review": { "content_digest": "b4a67f42022d0dc72773428e1e53c705a9675539181e5d1ccf6b1436cdf42540", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-who-2023-visual-estimation-inaccurate.json" } ], "decisions": [], "relationships": { "outgoing": [], "incoming": [ { "predicate": "addresses", "label": "Addressed by", "clinical_claim_not_fact": false, "other_entity_id": "maternal:who", "other_entity_in_atlas": true, "claim_id": null }, { "predicate": "addresses", "label": "Addressed by", "clinical_claim_not_fact": false, "other_entity_id": "maternal:calibrated-blood-collection-drape", "other_entity_in_atlas": true, "claim_id": null } ] }, "page_path": "bottlenecks/bottleneck-pph-detection/", "context_path": "api/v1/context/maternal--bottleneck-pph-detection.md" }