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Objective measurement of postpartum blood loss

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.

Also called Objective blood-loss measurement

  • Intervention
  • In this atlas

Overview

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.

About this intervention

Type
Test
Mechanism
Quantifies blood loss objectively, for example with a calibrated drape after vaginal birth, so bleeding is detected sooner than with visual estimation.

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

  • Recommendation Guidance Certainty not assessed

    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.

    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
    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
    Next evidence check due
    Not scheduled
    Sources and citations (4)

    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: recommendation text and category
      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
      Recommendation 21, Remarks: objective methods, drape evidence, link to treatment protocol, alternatives
      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.

    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
      Summary list of recommendations, footnote to Recommendation 21: integrated from the 2023 recommendations
      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.

    4. Background 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, Recommendation 1: the same wording in 2023
      How it applies
      WHO 2023 recommendations, CC BY-NC-SA 3.0 IGO; history only.
      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.

  • Recommendation Guidance Certainty not assessed

    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.

    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
    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
    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 22: criteria text and category
      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
      Recommendation 22, Remarks, bullet 1: therapeutic definition
      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.

    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
      Recommendation 22, Justification: evidence base and caesarean limitation
      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.

Guidance

Recommended: Objective measurement of postpartum blood loss

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.
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM.
Basis
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.

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.

Recommended: Objective measurement of postpartum blood loss

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.
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM.
Basis
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.

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.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Record details

Record id
maternal:objective-blood-loss-measurement
Content hash
bbe9f4107ca5cb63926d82e90e56a1f72f3fe63d28a5e4126835c871b2f6e052