Postpartum haemorrhage – current perspectives on prevention and management

Abstract

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, disproportionately affecting women in low- and middle-income countries, including India. Despite measurable advances in obstetric care over the past decade, delayed recognition, inconsistent application of the management ladder, and fragmented guidance across professional bodies have continued to contribute to deaths that are, in the overwhelming majority of cases, preventable. This review draws on the October 2025 consolidated guidelines issued jointly by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) - the first time these three bodies have produced a single unified framework on the subject - together with landmark trial evidence accumulated over the last decade, to synthesize current understanding of the prevention, diagnosis, and treatment of PPH. It examines risk factors and their limited predictive value, the increasingly central role of antenatal anemia correction alongside active management of the third stage of labor, the stepwise escalation of treatment from uterotonics and tranexamic acid through uterine balloon tamponade to surgical intervention, and the particular relevance of low-cost tamponade devices developed for and validated in resource-limited Indian settings. A comparative summary table is included to consolidate the escalation pathway into a single visual reference. The review is intended as an accessible, India-contextualized reference for postgraduate trainees and practicing obstetricians.