By The PPH Foundation

Referral delays are a silent driver of postpartum haemorrhage. For women with undiagnosed cervical disease, late referral often means arriving at higher-level facilities during labour, already in distress. At this stage, clinicians are forced into rapid decision-making, frequently resulting in emergency surgery, prolonged labour, or traumatic delivery, all of which substantially increase the risk of severe bleeding after birth.

Cervical disease that is identified late can compromise the progress of labour, increase tissue injury, and complicate uterine contraction after delivery. Studies consistently show that delayed referral is associated with higher rates of PPH, maternal shock, and emergency blood transfusion. Weak screening at primary facilities and poor communication between levels of care magnify this risk.

Dr Kireki Omanwa, President of the Kenya Obstetrical and Gynaecological Society and Co-Lead of the End Postpartum Haemorrhage Initiative, notes that “late referral converts manageable risk into life-threatening haemorrhage. Early detection and timely referral are among the most effective tools we have to prevent PPH.” The End PPH Initiative, implemented by the PPH Foundation in collaboration with the University of Nairobi, KOGS and the Midwives Association of Kenya, prioritises strengthening referral pathways as part of comprehensive PPH prevention.

Reducing postpartum haemorrhage requires moving referral upstream, before labour begins, when prevention is still possible.

Sources
World Health Organization, Managing complications in pregnancy and childbirth
Lancet Global Health, Referral delays and maternal outcomes
BMC Women’s Health, Barriers to cervical screening and referral

<a href="https://www.freepik.com/free-photo/patient-with-pregnancy-talking-physician-about-medical-care_20492722.htm">Image by DC Studio on Freepik</a>