Postpartum Hemorrhage
Investment Cases and Advocacy Materials
This page includes select materials to help country stakeholders make the case for investing in, preventing, and responding to, PPH.
The Joint Statement of Recommendation for the Use of Uterotonics for the Prevention of Postpartum Haemorrhage and the Joint Statement of Recommendation for the Use of Tranexamic Acid for the Treatment of Postpartum Haemorrhage are the culmination of strong and effective collaboration between FIGO and ICM – two of the world’s leading organizations representing specialists in midwifery, obstetrics and gynecology.
Joint Statement of Recommendation for the Use of Uterotonics for the Prevention of Postpartum Haemorrhage
International Federation of Gynecology and Obstetrics (FIGO) and International Confederation of Midwives (ICM), 2021.
In response to the availability of new evidence, FIGO and ICM strongly recommend the use of uterotonics during active management of third stage of labour to prevent PPH during vaginal birth or caesarean section. Our recommendations align with those made in the WHO 2018 recommendations on uterotonics for the prevention of postpartum haemorrhage.2
All health care providers should be trained and competent in both physiological and active management of third stage of labour.3 Women may choose physiological management of third stage of labour. In some settings, uterotonics may not be available or of good quality.
For active management of third stage of labour, it is recommended that one of the following uterotonics be used, preferably within one minute after birth. In settings where multiple uterotonic options are available, oxytocin (10IU, IM/IV) is the recommended uterotonic agent for the prevention of PPH for all births.4
In settings where oxytocin is unavailable (or its quality cannot be guaranteed), the use of other uterotonics (carbetocin, ergometrine/methylergometrine, oxytocin/ergometrine fixed-dose, misoprostol) are recommended for the prevention of PPH. Administration of uterotonics does not impede the delay of cord clamping.
Joint Statement of Recommendation for the Use of Tranexamic Acid for the Treatment of Postpartum Haemorrhage
International Federation of Gynecology and Obstetrics (FIGO). International Confederation of Midwives (ICM), 2021.
FIGO and ICM recommend the early use of TXA within three hours of birth, in addition to standard care for women with clinically diagnosed PPH following vaginal birth or caesarean section.
Standard care in the context of this recommendation covers routine care for PPH, including fluid replacement, administration of uterotonics, monitoring of vital signs, non-surgical (e.g. bimanual compression, intrauterine balloon tamponade, nonpneumatic antishock garment, aortic compression) and surgical interventions (e.g. brace sutures, arterial ligation, or hysterectomy) in accordance with WHO guidelines, FIGO recommendations or adapted local PPH treatment protocols.
TXA is a competitive inhibitor of plasminogen activation. It can reduce bleeding by inhibiting the enzymatic breakdown of fibrinogen and fibrin clots. TXA is in routine clinical use for reduction of blood loss in surgery and trauma and is listed on the WHO Essential Medicines List for management of postpartum haemorrhage.