A sweeping new series of reports published in The Lancet outlines a comprehensive strategy to prevent and treat postpartum hemorrhage, the leading cause of maternal death globally, responsible for 43,000 deaths each year. The condition affects approximately 27 million women annually, and while some bleeding after childbirth is normal, excessive bleeding can quickly become a medical emergency.
Dr. Olufemi Oladapo, a physician with the World Health Organization's Special Programme on Human Reproduction and co-author of the series, recalls a tragic case early in his career in Nigeria: a woman who had waited six years to become pregnant died from postpartum hemorrhage while he desperately searched for blood.
The reports emphasize that early detection is critical, as women often sense they are dying when bleeding too much, and without prompt action, death can occur within 10 to 20 minutes. A key recommendation is the use of a simple plastic drape placed beneath the woman after birth, which has calibrated lines to accurately measure blood loss, rather than relying on visual estimates that miss hemorrhages about half the time.
The researchers conducted a massive trial across Nigeria, Kenya, Tanzania, and South Africa involving more than 200,000 women, testing early detection with the drape, clear treatment criteria, and simultaneous interventions such as uterine massage, medication, and IV fluids. The results showed a massive decrease in severe bleeding.
The reports also highlight a stark disparity: the mortality rate from postpartum hemorrhage can be more than 200 times lower in well-resourced countries like the United States compared to under-resourced countries such as Afghanistan, Vietnam, or Nigeria. The drug oxytocin can stop bleeding but requires refrigeration, posing a challenge in low-resource settings.
The authors call for pit-crew-like simulation-based training for entire care teams. Dr.
Oladapo concludes that if current knowledge and tools are used, more than 95% of deaths could be prevented, and investing even 5% of the cost of managing hemorrhage in prevention would save both lives and money.