NEW diagnostic criteria for postpartum haemorrhage could support earlier identification and treatment while adding relatively modest treatment costs, according to new research.
Postpartum haemorrhage remains a leading cause of maternal mortality worldwide. In 2025, the WHO introduced expanded diagnostic criteria, defining postpartum haemorrhage as objectively measured blood loss of ≥300 ml accompanied by an abnormal haemodynamic sign, or blood loss of ≥500 ml, whichever occurs first within 24 hours of birth.
Researchers assessed how feasible, acceptable, and affordable these criteria are when implemented in routine clinical practice in a prospective, multi-country study
The prospective mixed-methods study included 18 primary, secondary, and tertiary healthcare facilities across Colombia, India, Kenya, Nigeria, Tanzania, and Thailand.
Researchers observed 5,264 births during a 5-week implementation period following training of healthcare workers in the new WHO criteria and first-response treatment bundle.
Among 4,361 births with objectively measured blood loss and at least one postpartum clinical assessment, postpartum haemorrhage was identified in 20.8% of participants using the new criteria.
By comparison, incidence was just 14.7% when the conventional ≥500 mL blood-loss threshold was applied.
Rates also differed considerably according to mode of birth, with postpartum haemorrhage identified in 13.7% of vaginal births compared with 30.7% of caesarean births.
Healthcare workers responded positively to the revised criteria, with 97.6% considering them feasible and 96.8% supporting their adoption following implementation.
However, researchers found that adherence was more variable. Overall, healthcare workers correctly diagnosed 54.1% of women who met the new criteria but adherence reached 85.6% following vaginal birth compared to only 34.5% following caesarean birth.
One important factor in this disparity was difficulty interpreting haemodynamic changes during caesarean delivery. Anaesthesia can alter blood pressure and pulse, making it difficult for clinicians to determine whether abnormal signs are caused by blood loss or anaesthetic agents.
For this reason, researchers highlighted the importance of multidisciplinary training involving anaesthesiologists and theatre staff as a consideration for wider, successful implementation of the new WHO criteria.
Objective monitoring of patients also presented practical challenges. Although blood loss and at least one postpartum clinical assessment were documented for 82.8% of the recorded births, regular monitoring of clinical signs was more difficult, particularly in facilities experiencing staff shortages, highlighting how lack of resources could affect the implementation of the new criteria.
All women diagnosed with postpartum haemorrhage received treatment, with 73.1% receiving the full first-response MOTIVE bundle recommended by the WHO, including uterotonics, tranexamic acid, uterine massage, and intravenous fluids.
Importantly, the earlier identification of postpartum haemorrhage under the expanded criteria was associated with only a modest increase in first-response treatment costs.
The additional weighted mean cost of treating each woman diagnosed with postpartum haemorrhage was USD4.60. In comparison, among women whose condition required escalation to more intensive care, the mean additional cost rose substantially to USD70.10 per woman, highlighting the considerably greater resources associated with managing more severe cases.
The researchers concluded that the new criteria are feasible, acceptable, and affordable across diverse healthcare settings and could enable earlier recognition and treatment of postpartum haemorrhage.
However, sustained implementation will require reliable access to essential supplies, objective blood-loss measurement, continued training, and stronger implementation strategies, particularly for caesarean births.
Minckas N et al. Implementation of new WHO postpartum haemorrhage diagnostic criteria in routine care: a multi-country mixed-methods study. The Lancet Obstetrics, Gynaecology, & Women’s Health, 2026. 2(e709-e19)
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