This week's Lancet has a series on postpartum haemorrhage.
EXECUTIVE SUMMARY
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide, occurring in an estimated 27 million women globally every year and causing about 43 000 maternal deaths. Common causes of PPH are uterine atony, trauma, retained placenta, and coagulopathy, with risk heightened by factors including caesarean birth, anaemia, and inadequate antenatal care. As outlined in this three-paper Series, prevention centres on addressing modifiable risk factors for PPH, reducing unnecessary caesarean sections, and administration of uterotonic prophylaxis. Early diagnosis by objective quantification of blood loss and monitoring of vital signs is crucial. Swift treatment following a standardised bundle, and avoiding delays along the management pathway, saves lives.
EXTRACTS
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.
Subjective visual estimation of blood loss should have no place in modern maternity practice. Calibrated blood collection drapes measure cumulative blood loss accurately,5 are easy to use,19 and can be part of a cost-effective strategy20 (figure 1). The drapes can be used after all vaginal births, including assisted births. The drape should be applied under the woman's buttocks right after childbirth to exclude amniotic fluid, but before delivery of the placenta, and should be kept for at least 1 h after childbirth.22 If bleeding is ongoing after 1 h, the drape should be kept in place for an additional hour. The drape can be tied around the woman's waist to allow her to adjust her position and move around. Cumulative blood loss volumes and vital signs should be checked at least every 15 min during this period.
Postpartum haemorrhage
https://www.thelancet.com/series-do/postpartum-haemorrhage
Postpartum Haemorrhage Online first June 12, 2026
Diagnosis and treatment of postpartum haemorrhage: a race against time
Prof Arri Coomarasamy et al.
The Lancet 2026
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01031-7/fulltext
COMMENT (NPW): Of particular interest is the innovation of a simple plastic drape with a calibrated pouch that can objectively measure blood loss. More information here: https://maternity.kimal.com/products/ammalife-pph-detection-drape/
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org