By The PPH Foundation

Postpartum haemorrhage, PPH, is most commonly associated with uterine atony, retained placenta, or birth-related trauma. However, an important and often overlooked contributor to excessive bleeding during and after childbirth is cervical disease, including cervical cancer and pre-cancerous lesions. Understanding this connection is critical to strengthening prevention efforts and improving maternal survival.

Cervical cancer remains one of the most prevalent cancers among women in low- and middle-income countries, including Kenya. Many women of reproductive age enter pregnancy without having undergone routine cervical screening. During pregnancy, cervical tissue becomes more vascular and fragile, and undiagnosed lesions can bleed easily during labour, delivery, or routine obstetric procedures. This increases the risk of severe bleeding and complicates efforts to control postpartum haemorrhage.

The End PPH Initiative has consistently emphasised that effective PPH prevention begins long before labour. Comprehensive antenatal risk assessment must include conditions affecting the cervix, particularly in settings where screening coverage is low. When cervical pathology goes undetected, an otherwise uncomplicated delivery can quickly escalate into a life-threatening emergency.

Prof Moses Obimbo, Project Lead of the End PPH Initiative, emphasises that effective PPH prevention begins well before labour. He highlights that comprehensive antenatal risk assessment must include conditions affecting the cervix, particularly in settings where screening coverage is limited. When cervical pathology is missed, an otherwise uncomplicated birth can quickly become a life-threatening emergency.

Recent public commentary by Dr Kireki Omanwa, President of the Kenya Obstetrical and Gynaecological Society and a Co-Lead of the End PPH Initiative, has reinforced the broader challenge of identifying and managing bleeding risks in maternity care. He has highlighted how gaps in diagnostic tools and systems for accurate blood loss measurement increase the likelihood of delayed response to haemorrhage. These gaps are especially dangerous when underlying conditions, such as cervical disease, are present but unrecognised.

The link between cervical cancer and postpartum haemorrhage also exposes wider health system fragmentation. Cervical cancer screening, antenatal care, and maternity services are often delivered in isolation, missing opportunities for early detection and coordinated care. Integrating cervical screening into routine maternal health services would allow providers to identify high-risk pregnancies early and plan safer deliveries with appropriate referral and blood preparedness.

Addressing cervical cancer as part of maternal health care is therefore essential to ending postpartum haemorrhage. Strengthening screening, improving referral pathways, and ensuring preparedness for obstetric bleeding will move health systems closer to preventing avoidable maternal deaths and safeguarding women before, during, and after childbirth.

Sources
• World Health Organization, Postpartum haemorrhage and maternal mortality data
• Kenya Obstetrical and Gynaecological Society, maternal health and PPH guidance
• The Standard, reporting on maternal bleeding risks and clinical preparedness featuring Dr Kireki Omanwa

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