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Late detection of postpartum haemorrhage

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.

Also called PPH detection gap

  • Bottleneck
  • In this atlas

Overview

Technical summary

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.

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.

Stage
Detection and diagnosis in the first hours after birth
Why it is severe
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

  • Burden Evidence synthesis Certainty not assessed

    WHO's 2023 recommendations say there were an estimated 287 000 maternal deaths worldwide in 2020, most of them in the world's least developed countries. WHO says obstetric haemorrhage is the leading cause of maternal mortality, accounting for 27% of all maternal deaths occurring worldwide each year, and that most of these deaths are due to postpartum haemorrhage. WHO estimates that about 14 million women experience PPH each year.

    Applies to Maternal
    • Women who died of maternal causes worldwide (2020 estimate) and women who experience postpartum haemorrhage each year (WHO estimate).
    • Not stated in the source
    • Worldwide. WHO says most deaths occurred in the world least developed countries.
    • Pregnancy, childbirth and the postpartum period
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not applicable (burden estimate)
    Certainty method
    Not assessed
    Limitations
    These are WHO estimates in an executive summary, not counts. The 27% is a share for obstetric haemorrhage as a whole, and the passage dates only the 287 000 figure to 2020. The 2025 WHO statement that PPH accounts for nearly one fifth of all maternal deaths has a different basis and is a separate claim. The two figures are not combined or reconciled. The sources WHO cites were not read.
    Last checked
    2026-10-11
    Next evidence check due
    Not scheduled
    Sources and citations (1)

    1. Supports WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum haemorrhage

      Guideline · 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. · Published 2023-12-21 · isbn: 978-92-4-008539-8

      Locator
      Executive summary, Introduction, para 1
      How it applies
      WHO 2023 recommendations, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      36364aa61f4e3b6dc00561e5a5d6aff380639230952bda6cab1db58d81c66ad8
      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.

  • Burden Evidence synthesis Certainty not assessed

    WHO's 2025 consolidated guideline says postpartum haemorrhage accounts for nearly one fifth of all maternal deaths worldwide and is the main cause of maternal death in most low-income countries. It says about 80% of related deaths occur in low- and middle-income countries, particularly in sub-Saharan Africa and South Asia.

    Applies to Maternal
    • Maternal deaths worldwide, with the share attributed to postpartum haemorrhage, and the share of related deaths in low- and middle-income countries.
    • Not stated in the source
    • Worldwide, with a focus on low- and middle-income countries, particularly in sub-Saharan Africa and South Asia.
    • Pregnancy, childbirth and the postpartum period
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not applicable (burden statement). The 2025 text gives no year for its figures.
    Certainty method
    Not assessed
    Limitations
    The 2025 text gives no year for these figures and cites a reference that was not read. The 2023 WHO figure (obstetric haemorrhage as 27% of maternal deaths) has a different basis and is a separate claim. The two are not combined or reconciled.
    Last checked
    2026-10-11
    Next evidence check due
    Not scheduled
    Sources and citations (2)

    1. Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage

      Guideline · 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. · Published 2025-10-05 · isbn: 978-92-4-011563-7

      Locator
      Executive summary, Introduction, para 1: nearly one fifth of maternal deaths
      How it applies
      WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de
      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.

    2. Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage

      Guideline · 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. · Published 2025-10-05 · isbn: 978-92-4-011563-7

      Locator
      Introduction, para 4: about 80% of related deaths in low- and middle-income countries
      How it applies
      WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de
      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.

Current efforts

Claims and evidence

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.
Eligibility: 1 inclusion criterion; exclusion criteria not stated
Included
  • Any woman giving birth, by vaginal birth or caesarean section
Excluded
None stated

  • Description Evidence synthesis Certainty not assessed

    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.

    Applies to Maternal
    • 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.
    • Not stated in the source
    • Global (WHO guidance intended to inform national and subnational policy).
    • 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.
    Certainty method
    Not assessed
    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.
    Last checked
    2026-10-11
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    1. Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage

      Guideline · 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. · Published 2025-10-05 · isbn: 978-92-4-011563-7

      Locator
      Recommendation 21, Remarks, bullet 1: visual estimation frequently inaccurate
      How it applies
      WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de
      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.

    2. Supports WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum haemorrhage

      Guideline · 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. · Published 2023-12-21 · isbn: 978-92-4-008539-8

      Locator
      Table 1, Remarks, Assessment of postpartum blood loss: the same remark in 2023
      How it applies
      WHO 2023 recommendations, CC BY-NC-SA 3.0 IGO.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      36364aa61f4e3b6dc00561e5a5d6aff380639230952bda6cab1db58d81c66ad8
      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.

    3. Background Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage

      Guideline · 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. · Published 2025-10-05 · isbn: 978-92-4-011563-7

      Locator
      Executive summary, Introduction, para 2: delayed diagnosis and late use of interventions
      How it applies
      WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de
      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.

Record details

Record id
maternal:bottleneck-pph-detection
Content hash
0d8b0ea97ec21eda15280044ce9efab5c3e96ebfba0f98212c771fcc23bcf9b2