By PPH Foundation

The first 10 minutes after the onset of postpartum haemorrhage are often the difference between life and death. The World Health Organization emphasizes that postpartum haemorrhage can escalate rapidly and unpredictably, requiring immediate, coordinated action to prevent fatal outcomes. Globally, the condition accounts for over 20 percent of maternal deaths, with the majority occurring in low- and middle-income countries where delays in response remain a critical challenge.

In response, global guidelines now recommend a rapid, bundled approach to care. According to WHO, FIGO, and the International Confederation of Midwives, once postpartum haemorrhage is identified, health workers must act immediately using a combination of interventions rather than a step-by-step delay. This includes uterine massage, administration of oxytocin, use of tranexamic acid, rapid intravenous fluids, examination for causes of bleeding, and escalation of care if needed.

This shift toward immediate, simultaneous action is backed by strong clinical evidence. Research highlighted in WHO guidance shows that delays in intervention significantly increase mortality risk, while early treatment, particularly within the first minutes, dramatically improves survival outcomes. Studies also show that administering tranexamic acid within three hours of birth reduces the risk of death due to bleeding, with effectiveness decreasing by about 10 percent for every 15-minute delay.

Dr Kireki Omanwa, a Gynaecologist and a Co-Lead in the End PPH Initiative, underscores the urgency of this response, noting that “postpartum haemorrhage does not wait, and neither should we. The speed and coordination of the first response determine whether a mother survives.” His remarks reflect frontline realities where hesitation or fragmented care can quickly lead to irreversible complications.

Despite the availability of clear guidelines, implementation gaps persist. Evidence from global reviews shows that lifesaving interventions are often applied too late or inconsistently due to delayed recognition, limited resources, or lack of trained personnel. This reinforces the need for preparedness, simulation training, and strengthened health systems to ensure that every facility can respond effectively within those critical first minutes.

Ultimately, the first response to postpartum haemorrhage is not just a clinical protocol, it is a race against time. Ensuring that health workers are equipped, trained, and ready to act immediately is one of the most important steps toward ending preventable maternal deaths. Every minute matters, and every action counts.

Sources
World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva, World Health Organization, 2012, updated guidance 2017.

World Health Organization. Trends in maternal mortality 2000 to 2020, estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva, World Health Organization, 2023.

International Federation of Gynecology and Obstetrics, FIGO, International Confederation of Midwives, ICM. Joint statement of recommendation for the use of uterotonics for the prevention of postpartum haemorrhage. 2014, updated FIGO PPH bundle guidance 2022.

World Health Organization. WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage. Geneva, World Health Organization, 2017.

Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum haemorrhage, an international, randomised, double-blind, placebo-controlled trial. The WOMAN Trial. The Lancet. 2017, Volume 389, Issue 10084.

Gallos ID, Papadopoulou A, Man R, et al. Uterotonic agents for preventing postpartum haemorrhage, a network meta-analysis. Cochrane Database of Systematic Reviews. 2018, Issue 4.

Althabe F, Therrien MN, Pingray V, et al. Postpartum haemorrhage care bundles to improve adherence to evidence-based practices, a WHO technical consultation. BJOG An International Journal of Obstetrics and Gynaecology. 2020, Volume 127, Issue 7.

Salati JA, Leathersich SJ, Williams MJ, et al. Implementation of postpartum haemorrhage care bundles in low-resource settings, a systematic review. PLOS Medicine. 2021, Volume 18, Issue 8.

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