Cited by 194Maternal and fetal healthcareMaternal and Perinatal Health InterventionsBlood transfusion and management

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The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?

Weeks, A·2015·BJOG: An International Journal of Obstetrics & Gynaecology

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Abstract

Postpartum haemorrhage (PPH) remains a major cause of maternal deaths worldwide, and is estimated to cause the death of a woman every 10 minutes. This review presents the latest clinical advice, including new evidence on controlled cord traction, misoprostol, and oxytocin. The controversy around the diagnosis of PPH, the limitations of universal prophylaxis, and novel ways to provide obstetric first aid are also presented. It ends with a call to develop high‐quality front‐line obstetric services that can deal rapidly with unexpected haemorrhages as well as minimising blood loss at critical times: major abruption, placenta praevia, and caesarean for prolonged labour.

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Self-citation
Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health
Sheldon, W. R., Blum, J., Vogel, J. P., Souza, J. P., Gülmezoglu, A. M., & Winikoff, B. (2014) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12636 · Cited by 378
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Research works printed but not linked: 3

Confidential Enquiry into Maternal and Child Health (CEMACH), 2006, Saving Mothers' Lives 2003‐2005
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Background
Compression of the lower uterine segment (COLUS) is an effective method of bleeding cessation during caesarean section on the background of placenta previa
Лакатош, П. В., Лакатош, В. П., Купчик, В. И., Kostenko, O. Y., & Антонюк, М. И. (2020) · Reproductive Endocrinology · doi:10.18370/2309-4117.2020.54.67-71 · Cited by 2
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Implementation of Postpartum Hemorrhage Emergency Care Using a Bundle Approach at a Tertiary Care Hospital in North India
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“There is one death every 10 minutes somewhere in world due to PPH.(1) WHO estimates that PPH accounts for nearly 30% at maternal death worldwide with an estimated 20 million deaths annually.”
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Major obstetric hemorrhage management
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“PPH is a significantly underestimated obstetric problem, primarily because a lack of definition and diagnosis [2, 3].”
Background
MODERN VIEWS ON OXYTOCICS IN OBSTETRICS PRACTICE
Mandal, M., Bhattacharya, D., Bagchi, D., Chattopadhyay, S., & Pal, S. (2016) · Journal of Evolution of Medical and Dental Sciences · doi:10.14260/jemds/2016/1183
To study the association of high risk factors and the postpartum hemorrhage at Tertiary Care Centre of Indore
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“[7] It occurs more commonly in those who: already have a low amount of red blood, are Asian, with bigger or more than one baby, are obese or are older than 40 years of age.”
BackgroundInfluential
Carbetocin versus oxytocin for the prevention of postpartum haemorrhage during caesarean section-A study of 100 cases in Combined Military Hospital, Momenshahi
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“estimated to cause the death of a woman every 10 minutes [1] .”
Background
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chamayasinta, A. S. R., Sitepu, M., & Aldiansyah, D. (2019) · Journal of Emerging Technologies and Innovative Research
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Safety Profile and Efficacy of Tranexamic Acid on Haemorrhage during and after the Caesarean Section
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“Secondary postpartum bleeding is that which occurs after the first day and up to six weeks after childbirth (Weeks, 2015).”
Background
Peripartale Komplikationen
Crombach, G., Drack, G., Hösli, I., Kainer, F., Kouskouti, C., Louwen, F., & Seelbach-Göbel, B. (2021) · Elsevier eBooks · doi:10.1016/b978-3-437-23753-9.00024-4
Peripartale Komplikationen
Crombach, G., Drack, G., Hösli, I., Kainer, F., Louwen, F., Petersen, E. E., & Seelbach-Göbel, B. (2016) · Elsevier eBooks · doi:10.1016/b978-3-437-23752-2.00024-9
Nesa Days 2015, Conference Report
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Стан системного транспорту кисню залежно від показників гематокриту та гемоглобіну в умовах крововтрати в породіль
Мityuryev, D. S., Loskutov, О. А., & Zezer, A. A. (2022) · EMERGENCY MEDICINE · doi:10.22141/2224-0586.18.2.2022.1477
A multi-attribute utility framework for patients to determine childbirth method considering uncertainties, patient preferences, risk attitudes, and pregnancy complications
Aziz, R. A., & Zhuang, J. (2022) · IISE Transactions on Healthcare Systems Engineering · doi:10.1080/24725579.2022.2149637 · Cited by 1
Is Adenomyosis a Rare Cause of Post Partum Hemorrhage?
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Descriptive statistical study of the most important possible causes of obstetric and postpartum hemorrhage in Thi-Qar province
Oudha, M. K., & Al-Muhsen, W. R. N. (2023) · University of Thi-Qar Journal of Science · doi:10.32792/utq/utjsci/v10i1(si).994
Secondary postpartum hemorrhage after pineapple juice- a case report
Thomas, C. R., Nair, S. S., Puthenveettil, N., & Sudhakar, N. (2023) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20232748
Uterine Cooling During Cesarean Section an Attempt to Reduce Blood Loss and Atonic Post-Partum Hemorrhage
elbehery, H., HASSAN, M. S. E., El-gareeb, M. S., & Fyala, E. A. (2023) · Evidence Based Women s Health Journal · doi:10.21608/ebwhj.2023.223472.1257
“PPH treatment covers both medical and surgical treatment, and Supportive care, such as compression garments [8] .”
Background
Pathologie der Plazentarperiode:Antepartuale und Peripartuale Hämorrhagie
Schlembach, D., Mörtl, M., Brezinka, C., & Henrich, W. (2023) · Springer Reference Medizin · doi:10.1007/978-3-662-44369-9_40-2
A cohort analysis of incidence and antepartum risk factors of severe postpartum haemorrhage in anaemic pregnant women in Lagos, NigeriaPreprint
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Fatores de Risco e Intervenções para Prevenir a Hemorragia Pós-Parto: Uma Revisão Sistemática
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“Diversos estudos têm identificado uma série de fatores de risco potenciais para a HPP, incluindo a história de HPP anterior, parto vaginal instrumental, trabalho de parto prolongado, entre outros disso, uma busca manual nas referências dos artigos selecionados foi realizada para identificar estudos adicionais.”
BackgroundInfluential
Postpartum haemorrhage: latest developments in prediction, drug treatment and monitoring
Phan, T., & Weeks, A. D. (2024) · British Journal of Midwifery · doi:10.12968/bjom.2024.32.4.190
Self-citation
HUBUNGAN PARTUS LAMA DENGAN KEJADIAN ATONIA UTERI PADA IBU BERSALIN DI BPM NY"S" DESA PRAMBON NGANJUK
Masyayih, W. A., Hıdayatı, N., & Astuti, A. S. (2024) · PRIMA WIYATA HEALTH · doi:10.60050/pwh.v5i2.73
The last resort that saved two lives: Emergency obstetric hysterectomy
Nair, P. (2025) · RMC Global Journal · doi:10.25259/rmcgj_4_2024
Preoperative Oxytocin Infusion to Reduce Blood Loss During Emergency Cesarean Section: A Double-Blind Randomized Controlled Trial
Nwigboji, W. N., Egede, J. O., Ajah, L. O., Nwali, S. A., Ozonu, N. C., & Nwali, M. I. (2025) · International Journal of Medicine and Health Development · doi:10.4103/ijmh.ijmh_38_24
Evaluation of the Association Between Postpartum Hemorrhage and Antidepressant Use: A Mendelian Randomization Study
Chen, Z., Lv, Q., Lin, S., Lin, W., & Zhuang, W. (2025) · Drugs - Real World Outcomes · doi:10.1007/s40801-025-00490-1
“Postpartum hemorrhage (PPH) is the leading cause of global maternal mortality, accounting for 30% of maternal deaths [1–3].”
Peripartale Komplikationen
Hollatz-Galuschki, E., Hösli, I., Kainer, F., Kehl, S., Kouskouti, C., Louwen, F., & Seelbach-Göbel, B. (2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21097-6.00024-x
Design and context of use of postpartum haemorrhage kits in the UK: a qualitative study combining human factors and social science analysisPreprint
Woodward, M., Powell, A., Dixon‐Woods, M., Burt, J., Winter, C., Lattey, K., Draycott, T. J., PPH Kits Contributor Group, & van der Scheer, J. W. (2025) · medRxiv · doi:10.1101/2025.09.15.25335093
“…requires a multi-professional response – typically within minutes of onset – using key interventions such as intravenous fluid replacement, medications to contract the uterus (uterotonics), medications to reduce bleeding (e.g. tranexamic acid), or physical techniques such as uterine massage [7-12].”
Additional file 2 of Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives
Voillequin, S., Rozenberg, P., Ravaud, P., & Rousseau, A. (2022) · Figshare · doi:10.6084/m9.figshare.19642120
Additional file 7 of Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study
Henry, J., Clarke‐Deelder, E., Han, D., Miller, N., Opondo, K., Oguttu, M., Burke, T. F., Cohen, J. L., & McConnell, M. A. (2022) · Figshare · doi:10.6084/m9.figshare.21542025
Additional file 1 of Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study
Henry, J., Clarke‐Deelder, E., Han, D., Miller, N., Opondo, K., Oguttu, M., Burke, T. F., Cohen, J. L., & McConnell, M. A. (2022) · Figshare · doi:10.6084/m9.figshare.21542004
Additional file 6 of Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study
Henry, J., Clarke‐Deelder, E., Han, D., Miller, N., Opondo, K., Oguttu, M., Burke, T. F., Cohen, J. L., & McConnell, M. A. (2022) · Figshare · doi:10.6084/m9.figshare.21542019
Postpartum haemorrhage
(2019) · Cambridge University Press eBooks · doi:10.1017/9781108684729.080
Additional file 5 of Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study
Henry, J., Clarke‐Deelder, E., Han, D., Miller, N., Opondo, K., Oguttu, M., Burke, T. F., Cohen, J. L., & McConnell, M. A. (2022) · Figshare · doi:10.6084/m9.figshare.21542016
Additional file 2 of Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study
Henry, J., Clarke‐Deelder, E., Han, D., Miller, N., Opondo, K., Oguttu, M., Burke, T. F., Cohen, J. L., & McConnell, M. A. (2022) · Figshare · doi:10.6084/m9.figshare.21542007
Additional file 1 of Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives
Voillequin, S., Rozenberg, P., Ravaud, P., & Rousseau, A. (2022) · Figshare · doi:10.6084/m9.figshare.19642117
Additional file 3 of Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study
Henry, J., Clarke‐Deelder, E., Han, D., Miller, N., Opondo, K., Oguttu, M., Burke, T. F., Cohen, J. L., & McConnell, M. A. (2022) · Figshare · doi:10.6084/m9.figshare.21542010
Additional file 4 of Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study
Henry, J., Clarke‐Deelder, E., Han, D., Miller, N., Opondo, K., Oguttu, M., Burke, T. F., Cohen, J. L., & McConnell, M. A. (2022) · Figshare · doi:10.6084/m9.figshare.21542013
Postpartum Hemorrhage in a Large Prospective Cohort Study: Is Uterine Atony really the Main Culprit?Preprint
Korte, W., Hothorn, T., Burgi, J. J., Rösslein, M., Kölble, N., & Haslinger, C. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6121827
Design and context of use of postpartum haemorrhage kits in the UK: a qualitative study combining human factors and social science analysis
Woodward, M., Powell, A. E., Dixon‐Woods, M., Burt, J., Winter, C., Lattey, K., Draycott, T. J., & van der Scheer, J. W. (2026) · Applied Ergonomics · doi:10.1016/j.apergo.2026.104763
Acute convulsions following sublingual misoprostol administration for postpartum hemorrhage: a report of two cases
Rundla, S. R., Dadhwal, A., Katoch, T., & Sharma, S. (2026) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20260916
Qualité des soins en salle de naissance et perspectives des mères
Gaucher, L. (2020) · theses.fr (ABES) · doi:10.70675/7158ccf4z3a83z405ezab23z392da7bb9532
Pathology of the Placental Period: Antepartum and Peripartum Hemorrhage
Schlembach, D., Moertl, M. G., Brezinka, C., & Henrich, W. (2026) · Springer eBooks · doi:10.1007/978-3-662-70578-0_50
BindingDB Entry 50007931: Fibrinolysis Inhibitors: Potential Drugs for the Treatment and Prevention of Bleeding.
BindingDB (2021) · UC San Diego · doi:10.7270/q2vq361p
BindingDB Entry 50008853: Synthesis of oxytocin derivatives lipidated via a carbonate or carbamate linkage as a long-acting therapeutic agent for social impairment-like behaviors.
BindingDB (2021) · UC San Diego · doi:10.7270/q2n87f60
Mode of delivery and fetomaternal outcomes in patients with postpartum haemorrhage: a retrospective study at a tertiary care centre in India
Singh, D., Bhuvneshwari, & Khan, F. H. (2026) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20263986

Authors: Weeks, A.
Affiliations: University of Liverpool (GB)
Corresponding author: Weeks, A
ORCID: Weeks, A
Venue: BJOG: An International Journal of Obstetrics & Gynaecology
Publisher: Wiley
Published: 2014-10-07
Volume: 122
Issue: 2
Pages: 202-210
ISSN: 0306-5456 (ISSN-L)
1470-0328
1471-0528
DOI: 10.1111/1471-0528.13098
OpenAlex: W1984295142
Cited by: 192
References: 63
Citations by year: 2026: 8 · 2025: 14 · 2024: 11 · 2023: 17 · 2022: 27 · 2021: 21 · 2020: 24 · 2019: 21 · 2018: 12 · 2017: 12 · 2016: 16 · 2015: 7 · 2014: 1
FWCI: 1.81
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
PubMed (publishedVersion)
Funders: Gynuity Health Projects (MamaMiso)
NIHR (II-LA-0712-20007)
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Health Sciences › Medicine › Hematology › Blood transfusion and management
Keywords: postpartum hemorrhage, maternal mortality, controlled cord traction, misoprostol, oxytocin, placental abruption, placenta previa, bleeding prevention
MeSH terms: Blood Transfusion, Delivery of Health Care, Female, Postpartum Hemorrhage, Home Childbirth, Humans, Labor Stage, Third, Oxytocics, Pregnancy, Compression Bandages

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