By PPH Foundation

Postpartum haemorrhage, PPH, prevention cannot begin and end in the delivery room. Increasing evidence shows that a woman’s health throughout pregnancy can influence her vulnerability to severe bleeding and her ability to survive it when it occurs.

A 2025 systematic review and meta-analysis published in The Lancet identified several antenatal and pregnancy-related factors associated with PPH, including anaemia, multiple pregnancy, placenta praevia, macrosomia, sepsis, pre-eclampsia and gestational diabetes. The findings reinforce the importance of identifying risks early and ensuring women receive appropriate care before childbirth.

Prof Anne Kihara, FIGO President Emeritus and End PPH Initiative Co-Lead, has emphasised the importance of preparing women before they reach the labour ward. “Prevention must begin before pregnancy through pre-conception care, nutrition and treatment of conditions that can contribute to anaemia,” she said recently.

Anaemia is particularly important because women who enter labour with low haemoglobin have less physiological reserve to withstand blood loss. WHO’s 2025 PPH guidelines therefore recommend identifying and treating iron-deficiency anaemia early, alongside quality antenatal care and attention to other risk factors.

Preeclampsia also requires close attention. A 2025 systematic review involving more than two million pregnancies found that preeclampsia was associated with nearly twice the odds of PPH. Gestational diabetes and hyperglycaemia in pregnancy can also increase complications, including pre-eclampsia, macrosomia and birth-related complications, making appropriate monitoring and management important.

Kenya’s 2026 Basic Obstetric Protocols similarly place PPH alongside anaemia, hypertensive disorders, sepsis and other major maternal conditions requiring evidence-based care.

For the PPH Foundation, this reinforces a critical principle: preventing PPH requires action across the maternal health continuum. Early antenatal screening, treatment of anaemia, identification of pregnancy complications, birth preparedness, skilled care and access to blood must work together.

PPH may occur after childbirth, but opportunities to reduce its impact begin much earlier.

Sources

• WHO, Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, 2025.
• Yunas et al., Causes of and risk factors for postpartum haemorrhage: a systematic review and meta-analysis, The Lancet, 2025.
• Gallardo Cerna et al., Preeclampsia as a Risk Factor for Postpartum Hemorrhage: A Systematic Review and Meta-Analysis, 2025.
• WHO, Many pregnancy-related complications going undetected and untreated, 2025.
• Kenya Ministry of Health, Basic Obstetric Protocols 2026.
• Image by wavebreakmedia_micro on Magnific</a>