By PPH Foundation
A pregnancy that appears to be progressing normally can still end in a serious emergency after childbirth, including postpartum haemorrhage, PPH. Some of the conditions that increase the risk of PPH can develop during pregnancy, while others may give warning signs that should never be ignored. Recognising these signs early gives health workers an opportunity to manage complications, prepare for delivery and, where possible, reduce the risk of a crisis after birth.
Pregnancy naturally brings physical changes. Headaches, tiredness, nausea, back pain and swelling may occur without indicating a serious problem. But when a symptom becomes severe, persistent, sudden or unusual, it deserves attention.
According to Yunas et al. (2025), a systematic review and meta-analysis published in The Lancet involving more than 847 million women found that several conditions associated with pregnancy and childbirth were strongly linked to an increased risk of PPH. These included anaemia, previous PPH, sepsis, multiple pregnancy, placenta praevia and lack of antenatal care. Pre-eclampsia was also identified as a risk factor with a moderate association with PPH. The findings reinforce the importance of identifying and managing complications during pregnancy rather than waiting until delivery.
One condition that deserves particular attention is pre-eclampsia. It usually develops after 20 weeks of pregnancy and is characterized by high blood pressure, sometimes accompanied by signs of damage to other organs.
The World Health Organization's 2025 fact sheet on pre-eclampsia notes that severe headache, blurred vision or other visual disturbances, upper abdominal pain, nausea and vomiting, and swelling of the hands and face can occur with the condition. However, some women may have few or no noticeable symptoms, making routine antenatal monitoring especially important (WHO, 2025).
“Pregnancy is a period when women should pay attention to changes in their bodies and seek help when something does not feel right. Some complications may initially present with symptoms that appear minor, but early assessment gives health workers a better opportunity to intervene before the condition becomes severe,” says Dr. Kireki Omanwa, Co-Lead of the End PPH Initiative.
His message is particularly relevant to PPH because prevention does not begin when a woman starts bleeding. It begins during pregnancy, through identifying conditions such as anaemia, hypertension and other complications that can affect how well a woman is able to withstand blood loss or increase her risk of complications during childbirth.
The 2025 WHO, FIGO and ICM consolidated guidelines on PPH emphasise that antenatal care forms part of the continuum of PPH prevention. The guidelines specifically highlight the importance of addressing anaemia during pregnancy because it increases the likelihood of PPH and can worsen the consequences of blood loss when haemorrhage occurs (WHO, 2025).
This makes antenatal care more than a routine appointment. It is an opportunity to identify risks that may not be obvious to the woman herself.
WHO recommends at least eight contacts with a health professional during pregnancy. These visits allow health workers to monitor the mother's health and the baby's development, check blood pressure, conduct appropriate tests and identify possible complications, even when a woman feels well (WHO, 2025).
Some warning signs, however, require immediate attention.
Vaginal bleeding during pregnancy should be assessed by a health professional. Severe abdominal pain should not simply be attributed to the physical changes of pregnancy, particularly when it is persistent or accompanied by other symptoms. A severe or persistent headache, especially when combined with blurred vision, can signal a hypertensive disorder. Sudden swelling of the face and hands also warrants assessment.
Changes in the baby's movements are another important warning sign. Once fetal movements have become established, a noticeable reduction or cessation of movement should prompt immediate medical attention. WHO advises pregnant women to seek emergency care when fetal movements decrease or stop rather than relying on home monitoring devices to determine whether the baby is well (WHO, 2025).
The warning signs do not end when the baby is born.
A woman who has just delivered should also know that heavy vaginal bleeding, passing large blood clots, persistent headache, fever, difficulty breathing or seizures require urgent medical attention. WHO identifies heavy bleeding and large clots among the warning signs requiring immediate help during the postnatal period (WHO, 2025).
This is particularly important because PPH can progress rapidly. The updated 2025 WHO guidelines, developed with FIGO and ICM, call for earlier detection and response, including objective measurement of blood loss and action before bleeding becomes catastrophic. The guidelines note that many cases occur without identifiable risk factors, making preparedness essential for every birth (WHO, 2025).
For families, this means understanding that seeking care early is not an overreaction. A woman does not need to wait until a symptom becomes unbearable before reporting it. Partners and relatives also have a role in encouraging women to seek care when they notice concerning changes.
For health workers, it means looking beyond whether a pregnancy appears uncomplicated. A woman may feel well and still have a condition that requires monitoring. Conversely, a woman may have a symptom that turns out to be harmless but needs assessment before that can be established.
Ultimately, protecting women from complications such as PPH requires attention across the entire continuum of care, from pregnancy and childbirth to the hours and days after delivery.
A warning sign does not necessarily mean that something is seriously wrong.
But ignoring one can mean losing the opportunity to find out early.
When it comes to pregnancy, listening to the body's quiet warnings may be one of the most important steps towards preventing a crisis before it begins.
References
World Health Organization. (2025). Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. World Health Organization.
World Health Organization. (2025). Pre-eclampsia. World Health Organization.
World Health Organization. (2025). WHO recommendations on maternal health: Guidelines approved by the WHO Guidelines Review Committee, 2nd ed. World Health Organization.
Yunas, I., Islam, M. A., Sindhu, K. N., et al. (2025). Causes of and risk factors for postpartum haemorrhage: A systematic review and meta-analysis. The Lancet, 405(10488), 1468–1480.
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