{ "release_id": "15708f235d73cd42", "id": "maternal:objective-blood-loss-measurement", "owner": "maternal", "kind": "intervention", "slug": "objective-blood-loss-measurement", "name": "Objective measurement of postpartum blood loss", "aliases": [ "Objective blood-loss measurement" ], "atlases": [ "maternal" ], "summary_plain": "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.", "summary_technical": "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.", "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": { "subtype": "test", "mechanism": "Quantifies blood loss objectively, for example with a calibrated drape after vaginal birth, so bleeding is detected sooner than with visual estimation.", "taxonomy_codes": [] }, "content_digest": "bbe9f4107ca5cb63926d82e90e56a1f72f3fe63d28a5e4126835c871b2f6e052", "review": { "content_digest": "bbe9f4107ca5cb63926d82e90e56a1f72f3fe63d28a5e4126835c871b2f6e052", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "15708f235d73cd42", "id": "maternal:claim-who-2025-pph-21-objective-measurement", "owner": "maternal", "subject_entity_id": "maternal:objective-blood-loss-measurement", "category": "recommendation", "statement": "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.", "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": "guidance", "certainty": "not_assessed", "certainty_method": null, "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.", "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: recommendation text and category", "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": "Recommendation 21, Remarks: objective methods, drape evidence, link to treatment protocol, alternatives", "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": "context", "locator": "Summary list of recommendations, footnote to Recommendation 21: integrated from the 2023 recommendations", "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": "context", "locator": "Table 1, Recommendation 1: the same wording in 2023", "applicability_note": "WHO 2023 recommendations, CC BY-NC-SA 3.0 IGO; history only.", "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" } } ], "review": { "content_digest": "0ea3051e8d917423316a3208f01cb38e9d3602cb2c54471af90fe06c8193e017", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-who-2025-pph-21-objective-measurement.json" }, { "release_id": "15708f235d73cd42", "id": "maternal:claim-who-2025-pph-22-diagnostic-criteria", "owner": "maternal", "subject_entity_id": "maternal:objective-blood-loss-measurement", "category": "recommendation", "statement": "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.", "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": "guidance", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": "2026-10-11", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Recommendation 22: criteria text and category", "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. 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The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Recommendation 22, Remarks, bullet 1: therapeutic definition", "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. 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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_date": "2025-10-05", "effective_date_note": "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.", "superseded_by": null, "supersession_status": null, "claim_id": "maternal:claim-who-2025-pph-21-objective-measurement" }, { "type": "recommendation", "id": "maternal:rec-who-2025-pph-22", "direction": "for", "intervention_id": "maternal:objective-blood-loss-measurement", "context_id": "maternal:ctx-who-2025-pph-all-women-giving-birth", "guideline_snapshot_id": "maternal:who-9789240115637-pdf-2026-10-11", "issuer_id": "maternal:who", "jurisdiction": "Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM.", "strength_label": "Recommended", "strength_system": "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_date": "2025-10-05", "effective_date_note": "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. 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