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PPH — WHO 2025 MOTIVE bundle
New global guidance: act early, give everything together.
Source: WHO/FIGO/ICM consolidated PPH guideline (Oct 2025) · E-MOTIVE trialDiagnose PPH at 300 ml with any abnormal vital sign, or at 500 ml. Measure blood loss with a calibrated drape.
Give the bundle immediately
| M — Massage | Uterine massage. |
|---|---|
| O — Oxytocics | Oxytocin (carbetocin where the cold chain fails; misoprostol if no injectables). |
| T — Tranexamic acid | 1 g IV over 10 minutes; repeat once after 30 minutes if bleeding continues. |
| I — IV fluids | Crystalloid via large-bore cannulas. |
| V — Vaginal exam | Examine for tears, retained placenta. |
| E — Escalate | Senior help, theatre, blood, referral. |
In the E-MOTIVE trial, early detection plus the bundle cut severe PPH, laparotomy or death by about 60%.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.