WHO Consolidated Guideline for the Prevention, Diagnosis, and Treatment of Postpartum Haemorrhage
WHO announces the meetings of the postpartum haemorrhage guideline development group
The World Health Organization (WHO) is committed to driving public health impact in every country, ensuring healthy lives and promoting well-being for all at all ages. Through its unique normative function in health, WHO aims to provide global, evidence-informed recommendations to improve maternal and perinatal health.
Obstetric haemorrhage is the leading cause of maternal mortality, accounting for 27% of all maternal deaths. The majority of these deaths are due to postpartum haemorrhage (PPH), estimated to be around 70,000 maternal deaths worldwide annually.
Steps towards reducing the incidence and impact of PPH would significantly contribute to reducing maternal mortality and morbidity. Likewise, an improvement in the overall quality of maternal health care to prevent and treat complications such as PPH is critical to attaining the Sustainable Development Goals (SDGs) health targets.
Guidelines are needed to provide optimal, evidence-based care to women experiencing PPH.
Developing a consolidated guideline on the prevention, diagnosis and treatment of PPH
Effectively intervening against PPH requires understanding and addressing a range of interrelated clinical and nonclinical contributing factors. Risk factors include maternal anaemia, grand-multiparity, prolonged labour and multiple gestation. However, many women presenting with PPH have no identifiable risk factors. Thus, health workers must be prepared to quickly detect and manage excessive bleeding in all births. Uterine atony is the most common cause of PPH; other causes include vaginal and cervical trauma (lacerations), uterine rupture, retained placental tissue, and maternal bleeding disorders. Multiple causes of PPH can co-exist in the same woman, which means healthcare workers must be prepared to detect and treat PPH from all causes in all women giving birth. Appropriate treatment of PPH relies on a combination of medications and clinical interventions, with the ability to rapidly escalate to higher levels of care if the bleeding is unresponsive to initial treatment.
Despite the existence of recommended interventions for preventing, detecting and treating PPH, effective implementation of evidence-based interventions has lagged. Potentially lifesaving interventions may be used inconsistently or deployed late due to delayed detection of PPH. Current normative guidance is fragmented and, at times, contradictory across guideline developers, contributing to confusion in the field. Broader health system challenges, such as weak supply chains, human resource constraints, and limited blood transfusion capacity, hinder efforts to reduce PPH-related mortality and morbidity. Strong normative efforts that address these challenges have great potential to improve the global response to PPH.
The primary aim of the consolidated guideline is to improve the quality of care and outcomes for women giving birth, as it relates to PPH and its complications. The consolidated guideline will be a single, up-to-date repository for all global recommendations relating to PPH prevention, diagnosis and treatment. The guideline will address important gaps in existing global guidance on PPH, ensuring that recommendations are comprehensive, reliable, and consistent across international guidelines promoting translation of global recommendations into clinical practice, especially in high burden countries.
The desired impact of the consolidated guideline is the reduction of global PPH-related morbidity and mortality. The publication of the consolidated guideline will feed subsequent efforts described in the Roadmap to combat postpartum haemorrhage between 2023 and 2030, such as national tailoring of global guidance, comprehensive training and capacitation of healthcare workers, and health system strengthening efforts.
WHO is convening this WHO Guideline Development Group on:
- 10 – 11 September 2024 (15:00-18:00 CET the first day; 15:00-17:00 CET the second day) virtual
- 22 – 23 October 2024 (15:00-18:00 CET the first day; 15:00-17:00 CET the second day) virtual
- 2 – 4 or 10 – 12 December 2024 (9:00-17:00 CET each day) in-person
The objectives of these meetings are to:
- Review the evidence pertaining to approaches for preventing, diagnosing and treating PPH.
- Discuss and agree on recommendations on the approaches to prevent, diagnose and treat PPH.
In line with WHO policy on conflict of interest, members of the public and interested organizations can access the biographies of the GDG proposed members and inform WHO of their views about them.
All comments should be sent by email to [email protected] by 3 September 2024.
This WHO normative meeting is by invitation only.