Early recognition of postpartum haemorrhage, or PPH, saves lives. The World Health Organisation now emphasises acting early, once blood loss reaches 300 millilitres or if the mother shows abnormal vital signs, because waiting for traditional thresholds risks fatal delays. Clinicians are also urged to switch from visual estimates to objective measurement of blood loss, using calibrated collection drapes or similar devices to detect danger sooner.

What should families and health teams look for, in plain terms? The most obvious sign is heavy vaginal bleeding that soaks through more than one pad in an hour, or passing large clots or tissue. Yet not all dangerous bleeding is obvious. Some blood can be concealed inside the uterus, making a woman appear stable while she is losing large volumes. That is why monitoring vital signs is essential, because faintness, dizziness, a racing heart, cold and pale skin, or reduced urine output often signal that the body is failing to cope with blood loss.

Clinical signs of hypovolaemia (condition where the body loses a significant amount of blood or fluids, leading to a reduction in the volume of circulating blood,) may lag behind actual blood loss, so relying solely on how much blood is seen will miss many cases. Research shows that visual estimation routinely undercounts blood loss, often by a third or more, while calibrated drapes provide much more accurate measurement and prompt earlier action. Health facilities that adopt objective measurement catch haemorrhage earlier and start lifesaving interventions sooner.

Practical warning signs to watch for in the first hours after birth are a rapid pulse, low blood pressure, breathlessness, sweating, confusion or fainting, and a uterus that feels soft rather than firm when palpated. A soft, boggy uterus suggests uterine atony, the single most common cause of PPH, when the uterus fails to contract and clamp down on the vessels that supplied the placenta. In contrast, severe abdominal pain, visible lacerations, or persistent bleeding after the placenta is delivered point to trauma or retained tissue as the likely causes.

The new WHO guidance recommends a treatment bundle, meaning clinicians should apply several proven actions together rather than sequentially. From a recognition perspective, this means that as soon as measured blood loss reaches the early threshold or the mother shows worrying vital signs, the team should simultaneously give a uterotonic drug, initiate uterine massage, ensure intravenous access and fluids, and give tranexamic acid if within three hours of the onset of bleeding. If bleeding continues, mechanical options such as a uterine balloon tamponade and rapid referral for surgical care must follow without delay.

Community and family awareness matters too. In settings where many births still happen at home or in small clinics, teaching families to recognise heavy bleeding and the signs of collapse, and to seek immediate transfer to a facility, is crucial. Community health volunteers, traditional birth attendants, and birth companions can all be taught to watch for these warning signs and to act as first responders. Clear birth plans, transport arrangements, and knowledge of where blood transfusion services are available make a real difference.

Frontline clinicians and midwives say preparedness and teamwork save lives. Dr Eunice Atsali, midwife and maternal health specialist, notes that routine use of simple measurement tools, combined with rehearsed emergency drills, reduces hesitation and speeds treatment. Professor Moses Obimbo, Secretary of the Kenya Obstetrical and Gynaecological Society and Project Lead at PPH Foundation, adds that early detection is only useful if facilities have the medicines, supplies, and referral systems to respond immediately. Both point out that community awareness, professional training, and reliable supplies must work together.

In short, recognising PPH means looking beyond visible blood loss. Measure when you can, monitor always, and act early at the first signs of trouble. The new global guidance gives clinicians and communities clear, evidence-based thresholds and steps to prevent unnecessary deaths from postpartum haemorrhage. Every minute saved, saves a mother.

Sources
World Health Organization, WHO Recommendations on the Assessment of Postpartum Blood Loss and Use of a Treatment Bundle for Postpartum Haemorrhage, 2023
World Health Organization, Global Briefing on PPH Guidance and the 300 Millilitre Early Action Threshold, 2025
Centers for Disease Control and Prevention, Maternal Warning Signs, 2024
Lertbunnaphong T and colleagues, Visual Estimation Versus Objective Measurement of Postpartum Blood Loss, 2016
Akter S and colleagues, Detection and Management of Postpartum Haemorrhage, 2022