Diagnosis and treatment of postpartum haemorrhage: a race against time.

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Pooled sensitivity of visual estimation for PPH diagnosis at vaginal birth: 48% (misses 52% of PPH cases)

• Primary Outcome: Diagnostic accuracy of subjective visual estimation of blood loss for PPH detection at vaginal birth

• Nnt Or Sensitivity: Sensitivity 48% (95% CI 44–53%) — meaning visual estimation correctly identifies fewer than half of all PPH cases at vaginal birth; specificity not reported in abstract. PPH prevalence: 13% at vaginal birth, 31% at caesarean birth.

• Confidence Interval: 95% CI 44–53% for pooled sensitivity

Clinical Application

Calibrated blood collection drapes are low-cost, widely available, and feasible in both high- and low-resource settings. First-response treatment bundles and escalation protocols require institutional investment in training, protocol development, and multidisciplinary team coordination. Non-pneumatic anti-shock garments are low-cost temporising measures suitable for resource-limited environments. Australia has a PPH rate of approximately 13% of births, with PPH remaining a leading cause of severe maternal morbidity. The RACGP and RANZCOG have existing PPH guidelines broadly consistent with the WHO-FIGO-ICM recommendations described in this review. Calibrated blood collection drapes are available in Australian hospitals but not universally implemented. The recommendation to authorise midwives to administer all components of a first-response treatment bundle aligns with expanding midwifery scope of practice discussions in Australia. Oxytocin (first-line uterotonic) and tranexamic acid are both PBS-listed and widely available. Non-pneumatic anti-shock garments are not standard equipment in most Australian maternity units. The six-delays framework could be integrated into Australian maternity emergency training programs such as PROMPT (Practical Obstetric Multi-Professional Training). TGA-approved blood products and cell salvage technologies are available in tertiary Australian centres for refractory PPH management. All women giving birth vaginally or by caesarean section in any healthcare setting where PPH risk exists; particularly relevant for high-volume maternity units and settings with limited access to advanced haemostatic interventions

Abstract

Postpartum haemorrhage (PPH) is common, affecting an estimated 13% of women having vaginal birth and 31% of women having caesarean birth. Successful management of PPH requires early and accurate diagnosis and effective treatment. A systematic review found that subjective visual estimation of blood loss misses 52% of PPH diagnoses at vaginal birth (pooled sensitivity 48%, 95% CI 44-53), and probably more at caesarean birth. The WHO-International Federation of Gynecology and Obstetrics-International Confederation of Midwives consolidated guidelines on PPH therefore recommend objective quantification of blood loss with products such as a calibrated blood collection drape. When supported by a robust implementation strategy and a first-response treatment bundle, objective measurement of blood loss and monitoring of vital signs has been shown to diagnose PPH accurately and early, and improve clinical outcomes. Refractory PPH can progress to life-threatening PPH, which should be managed by a multidisciplinary team providing aggressive resuscitation and targeted treatment. Saving the life of a woman with excessive postpartum bleeding is a race against time. The six delays to avoid are: (1) in the diagnosis (by use of objective cumulative blood loss measurement and early trigger criteria), (2) in the first-response treatment (by authorising midwives to administer all components of a standardised bundle of interventions), (3) in the escalation (by use of explicit escalation criteria and red flags), (4) in the use of temporising measures (eg, non-pneumatic anti-shock garment), (5) in the identification and targeted management of any specific causes of bleeding, and (6) in the provision of blood and blood products. Quick actions to avoid these delays can mean the difference between life and death for a woman with PPH.

References

1. 1.Coomarasamy, A., Devall, A. J., Bell, S., Sindhu, K. N., Mammoliti, K.-M., Nausheen, S., Ali-Masri, H., Deneux-Tharaux, C., Homer, C. S. E., Miller, S., Kihara, A., Thangaratinam, S., Weeks, A., Wright, A., Hodgetts-Morton, V., Beeson, L. E., Allotey, J., Sobhy, S., Moran, N., Yunas, I., Oladapo, O. T., & Gallos, I. D. (2026). Diagnosis and treatment of postpartum haemorrhage: a race against time. The Lancet. https://doi.org/10.1016/S0140-6736(26)01031-7