By The PPH Foundation
Postpartum haemorrhage, PPH, is most often linked to uterine atony or retained placenta, yet cervical pathology remains an under-recognised contributor to severe bleeding during childbirth. Undiagnosed cervical lesions, including precancerous changes and cervical cancer, can significantly increase the risk of excessive bleeding during labour and delivery, particularly in settings where routine screening coverage remains low.
During pregnancy, the cervix undergoes physiological changes that make it more vascular and softer. When cervical lesions are present but undetected, this increased blood supply and tissue fragility heighten the risk of bleeding during cervical dilation, vaginal delivery, caesarean section, or routine obstetric interventions. In such cases, bleeding may be mistaken for typical labour-related blood loss, delaying timely recognition and response to postpartum haemorrhage.
Dr Kireki Omanwa, President of the Kenya Obstetrical and Gynaecological Society and Co-Lead of the End PPH Initiative, has repeatedly emphasised that unrecognised bleeding risks complicate obstetric care. He notes that when underlying conditions such as cervical disease are missed, even well-prepared maternity teams can face sudden, severe haemorrhage that is difficult to control without rapid escalation, blood access, and specialist input.
The challenge is compounded by gaps in antenatal care. Many women enter pregnancy without ever having undergone cervical screening, particularly in low-resource and underserved settings. Antenatal services often prioritise foetal monitoring and obstetric history, while cervical health receives limited attention unless symptoms are present. This leaves silent cervical disease undetected until labour, when options for prevention are limited.
Women with advanced cervical lesions face even greater risk. Tumour-related bleeding, associated anaemia, and poor tissue integrity can overwhelm standard PPH prevention measures. Without prior identification, facilities may be unprepared with adequate blood supplies, referral plans, or multidisciplinary support, increasing the likelihood of severe complications or maternal death.
Addressing this risk requires a shift in how maternal health services approach prevention. Integrating cervical screening into routine antenatal care, strengthening referral pathways, and ensuring blood preparedness for high-risk pregnancies are critical steps in reducing preventable haemorrhage. Identifying cervical lesions early allows health workers to plan safer deliveries, anticipate complications, and act swiftly when bleeding occurs.
Ending postpartum haemorrhage demands attention to risks that begin long before labour. Recognising undiagnosed cervical disease as a contributor to obstetric bleeding strengthens prevention efforts and brings health systems closer to the goal of ensuring that no woman dies from preventable bleeding after childbirth.
Sources
- World Health Organization, Cervical cancer and maternal health guidance
- World Health Organization, Postpartum haemorrhage prevention and management
- FIGO, Management of cervical disease during pregnancy
- Kenya Obstetrical and Gynaecological Society, maternal health and obstetric bleeding briefs
- End PPH Initiative technical insights and expert commentary
- <a href="https://www.freepik.com/free-photo/african-american-woman-holding-ribbon_17247863.htm">Image by wirestock on Freepik</a>