byLancet

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A new way of diagnosing heavy bleeding after birth (postpartum hemorrhage or PPH) is more effective at identifying women in need of treatment than the current diagnostic method, suggests a meta-analysispublishedinThe Lancet.

PPH is a leading global cause of maternal deaths during pregnancy. Treatment must be given quickly and delays in recognizing the condition cost lives. Doctors worldwide currently use a threshold of 500 mL or more of blood loss to diagnose PPH, however, this threshold is not based on strong evidence.

This study analyzed data from more than 300,000 women from 23 countries, to assess the sensitivity and specificity of using different warning signs to predict complications from PPH. Their study found:

The authors consulted with other experts and concluded that using diagnosis signs which catch more women with PPH (high sensitivity) should be prioritized over avoidingfalse positives(high specificity) and therefore the threshold of 300 mL blood loss plus high heart rate or vital signs suggestive of shock; orlow blood pressureor measuredblood lossthresholdof at least 500 mL (whichever occurs first) is the best diagnosis criteria to use for PPH.

The authors say their results provide a strong rationale for revisiting the current medical guidelines on PPH globally. They suggest that a clearer and more flexible definition based on theirdiagnostic criteriacould help health workers spot dangerous bleeding sooner, enable faster responses, and save the lives of many women around the world.

More information: Ioannis Gallos et al, Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis, The Lancet (2025). DOI: 10.1016/s0140-6736(25)01639-3 Journal information: The Lancet

Provided by Lancet