By PPH Foundation
When postpartum haemorrhage strikes, every minute counts. A woman can bleed to death within two hours if action is delayed, making a quick and coordinated response essential. The World Health Organisation estimates that PPH accounts for nearly a quarter of all maternal deaths globally, yet timely intervention can prevent almost all of them.
Prof Moses Obimbo Madadi, the Project Lead at PPH Foundation, explains that the key to saving lives lies in preparedness and early recognition. “The first step is to identify heavy bleeding immediately after delivery and initiate management without delay,” he says. “Once bleeding starts, the window for successful intervention is very narrow.”
The cornerstone of PPH management remains prompt administration of uterotonic drugs such as oxytocin or heat-stable carbetocin. When bleeding continues despite uterotonics, the next step is to use tranexamic acid, a medicine that helps the blood to clot. Findings from the landmark WOMAN Trial published in The Lancet confirmed that early administration of tranexamic acid within three hours of birth significantly reduces deaths from bleeding. This discovery transformed the global approach to PPH management.
Dr Frederick Kireki Omanwa, Consultant Obstetrician and Gynaecologist and President of the Kenya Obstetrical and Gynaecological Society (KOGS), says tranexamic acid has now become a must-have drug in all maternity wards. “The evidence is clear,” he says. “TXA is affordable, effective, and easy to administer. When given early, it saves lives.”
If medication fails, mechanical and supportive measures are critical. The uterine balloon tamponade, a simple device inserted into the uterus and filled with fluid to apply pressure on bleeding vessels, has proven lifesaving, particularly in facilities with limited surgical capacity. Recent trials in sub-Saharan Africa have shown that using balloon tamponade can reduce the need for hysterectomy and stabilise women while arranging transfer to higher-level care.
Another vital innovation is the Non-pneumatic Anti-Shock Garment, or NASG, designed to stabilise women experiencing severe blood loss. This reusable, lower-body suit applies pressure to redirect blood to vital organs and buys time for treatment or referral. Evaluations across Kenya, Nigeria, and Ethiopia have shown that NASG use can reduce maternal deaths by up to 50 per cent in emergency settings.
Dr Eunice Atsali, midwife and maternal health advocate at the PPH Foundation, highlights the importance of teamwork and simulation drills. “We train maternity teams to act fast and in sequence,” she says. “The moment heavy bleeding is detected, everyone has a role; one measures blood loss, another prepares medication, and another calls for help. Speed and coordination save lives.”
The latest WHO guidelines on postpartum haemorrhage, released in 2023, now emphasise an integrated “first response bundle” combining early administration of uterotonics, tranexamic acid, uterine massage, and fluid resuscitation to ensure that lifesaving actions are taken simultaneously, not sequentially. They also recommend the use of calibrated blood-collection drapes for accurate measurement of blood loss, and greater investment in health worker training, teamwork, and supply readiness.
Photo by Pixabay: https://www.pexels.com/photo/emergency-signage-263402/
Sources
• World Health Organisation, Updated Recommendations on the Treatment of PPH, 2023
• The WOMAN Trial, The Lancet, 2017
• Kenya Ministry of Health, PPH Management Guidelines, 2023
• PATH, Evaluation of the Non-pneumatic Anti-Shock Garment in Sub-Saharan Africa, 2022
• Kenya Obstetrical and Gynaecological Society, Emergency Response Training Report, 2024
• PPH Foundation Hospital Mentorship Program Data, 2024