By PPH Foundation
As the world marks World Preeclampsia Day on 22 May, growing evidence continues to show that hypertensive disorders in pregnancy are not only a major cause of maternal and newborn illness, but also a significant contributor to postpartum haemorrhage (PPH), the leading cause of maternal deaths globally. The relationship between preeclampsia and PPH is increasingly becoming an important concern in maternal health, particularly in low- and middle-income countries where delays in diagnosis, referral, and emergency obstetric care continue to place mothers at risk.
Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of organ damage, often occurring after 20 weeks of pregnancy. When not identified and managed early, it can progress into severe complications including seizures, stroke, organ failure, placental abruption, and excessive bleeding during or after childbirth. According to the World Health Organization, hypertensive disorders of pregnancy account for approximately 14 percent of maternal deaths globally, while postpartum haemorrhage contributes nearly 27 percent of maternal deaths worldwide. Recent evidence shows that women with preeclampsia face significantly increased risks of severe bleeding after delivery due to coagulation abnormalities, prolonged labour, placental complications, and the increased likelihood of emergency caesarean sections.
A 2024 systematic review published in the International Journal of Gynecology and Obstetrics found that women with severe preeclampsia were substantially more likely to develop postpartum haemorrhage compared to normotensive mothers, especially in settings with limited blood products and delayed obstetric response systems. Additional studies published in The Lancet Global Health and BMC Pregnancy and Childbirth have also linked poorly controlled hypertension in pregnancy with increased maternal intensive care admissions, severe anaemia, stillbirths, and maternal near-miss complications associated with obstetric bleeding.
In Kenya and across sub-Saharan Africa, the burden remains high. Data from recent maternal mortality reviews continue to show that hypertensive disorders and obstetric haemorrhage frequently coexist in maternal deaths, highlighting the need for integrated prevention and emergency response strategies. The challenge is worsened by limited antenatal screening, shortages of skilled health workers, inconsistent access to magnesium sulphate and antihypertensive medicines, and delays in referral systems, particularly in rural and underserved regions.
Prof Moses Obimbo, the End PPH Initiative Project Lead, says preventing postpartum haemorrhage must begin long before delivery by identifying and managing conditions that place mothers at higher risk during childbirth.
“Preeclampsia is not only a hypertension issue. It is a major obstetric emergency risk factor that increases the likelihood of postpartum haemorrhage, organ failure, stillbirth, and maternal death. Early antenatal screening, proper blood pressure control, timely referral, and preparedness for obstetric emergencies remain essential in protecting mothers and newborns,” he says.
Recent global recommendations continue to emphasise routine blood pressure monitoring during antenatal care, urine protein testing, improved nutrition, low-dose aspirin for high-risk pregnancies, skilled birth attendance, and strengthened emergency obstetric systems as key interventions for reducing maternal deaths associated with both preeclampsia and postpartum haemorrhage. Experts also continue to advocate for better blood systems, simulation-based obstetric training, and stronger community awareness to ensure women seek care early before complications escalate.
As countries continue working toward the Sustainable Development Goals on maternal survival, experts warn that progress will remain slow unless conditions such as preeclampsia and postpartum haemorrhage are addressed together within stronger, integrated maternal health systems. Preventing maternal deaths requires not only emergency response, but also early detection, preparedness, and sustained investment in quality maternal care.
Sources
- World Health Organization. Trends in Maternal Mortality 2000 to 2023. Geneva: WHO; 2025.
- Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2024;12(4):e540–e550.
- Ramasauskaite D, et al. Hypertensive disorders of pregnancy and risk of postpartum haemorrhage. International Journal of Gynecology and Obstetrics. 2024;169(2):214–221.
- Souza JP, et al. Maternal near miss and severe maternal outcomes associated with hypertensive disorders. The Lancet Global Health. 2024;12(2):e306–e316.
- BMC Pregnancy and Childbirth. Severe preeclampsia and maternal complications in low-resource settings. 2024;24:118.
- World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva: WHO; Updated guidance 2024.
- Image by pvproductions on Magnific</a>