An interactive teaching tool built from the 2026 Lancet three-part Series on PPH
Postpartum haemorrhage affects a woman roughly every 1.2 seconds and kills a mother every 12 minutes. Most of these deaths are judged preventable. This module distils the epidemiology, prevention, diagnosis, and treatment of PPH into explorable content, then tests your command of it. Every figure shown traces to one of the three Series papers — none is approximated.
Three peer-reviewed Series papers (The Lancet, June 12 2026) plus the underpinning trials and reviews they cite. Full Vancouver citations with annotations are on the Evidence page.
Five modules. Tap any to expand. Every number is sourced.
Definitions historically varied by both variable (blood loss alone vs. blood loss plus vital signs) and threshold (500 / 750 / 1000 mL). WHO resolved this through an individual-participant-data meta-analysis of 312,151 women across 23 countries, which identified the criteria below as having a prognostic sensitivity of 87–88% and specificity of 67–76% for maternal death or severe morbidity.
| Term | Definition |
|---|---|
| PPH | ≥300 mL + any abnormal haemodynamic sign, OR ≥500 mL — whichever first, within 24 h |
| Severe PPH | Objectively measured blood loss ≥1000 mL |
| Life-threatening PPH | Shock, collapse, or acute organ failure; usually ≥1500 mL but can occur lower (e.g. severe anaemia) |
| Refractory PPH | Not responded to the first-line treatment bundle |
| Primary / Secondary | Within 24 h / after the first 24 h of birth |
| Setting | Objective (drape) | Subjective (visual) |
|---|---|---|
| PPH at vaginal birth | 12.6% (10.1–15.2) | 3.9% (3.0–4.9) |
| PPH at caesarean | 30.9% (24.9–37.6) | 8.2% (3.7–14.3) |
| Severe PPH, vaginal | 3.3% (2.6–4.1) | 2.3% (1.3–3.6) |
Source: Yunas et al, prevalence meta-analysis (81 studies, 42.7M women); Coomarasamy Paper 1.
| Cause | Pooled rate (95% CI) | T |
|---|---|---|
| Uterine atony | 70.6% (63.9–77.3) | Tone |
| Genital tract trauma | 16.9% (9.3–24.6) | Trauma |
| Retained placenta | 16.4% (12.3–20.5) | Tissue |
| Abnormal placentation | 3.9% (0.1–7.6) | Tissue |
| Coagulopathy | 2.7% (0.8–4.5) | Thrombin |
Rates exceed 100% because causes co-occur. Source: Yunas et al, Lancet 2025.
Strong = OR >2 · Moderate = OR 1.5–2 · Weak = OR 1–1.5.
| Risk factor | Category | OR (95% CI) |
|---|
Source: Table 1, Coomarasamy Paper 1 (from Yunas et al and cited sources). Adjusted pooled ORs where available.
No prediction model reliably identifies who will bleed, so uterotonic prophylaxis is advocated for every birth. The network meta-analysis ranked agents by SUCRA (higher = better at preventing PPH ≥500 mL):
Affects ~37% of pregnant women globally; OR for PPH 2.36 (1.29–4.32). Defined as Hb <110 g/L (1st/3rd trimester) or <105 g/L (2nd). Treat anaemia: 120 mg elemental iron/day until Hb ≥110 g/L; IV iron if oral fails or correction is urgent.
Mean blood loss at vaginal birth is only 353 mL (median 220 mL) — so 500 mL is already well above average. Subjective visual estimation misses 52% of PPH (sensitivity 48%); a calibrated drape misses only 7% (sensitivity 93%). Neither training nor experience improves the eyeball method.
A true bundle: every element, every woman, every time the trigger is met — not an algorithm.
16.2% (497/3061) of women with PPH progress to refractory PPH despite first-line treatment. Refractory care follows three phases: assess & act → stabilise → operate, with temporising measures (bimanual compression, uterine tamponade, aortic compression, or a non-pneumatic anti-shock garment for transfer).
| Product | Trigger / target |
|---|---|
| Red cells | Severe PPH (≥1000 mL) or unstable; aim Hb ≥70 g/L |
| Fibrinogen (cryo/concentrate) | Keep Clauss fibrinogen >2 g/L |
| Platelets | Consider if <75×10⁹/L; aim >50×10⁹/L |
| Fresh frozen plasma | After 4 units RBC, or PT/aPTT >1.5× reference |
Distinct from the older "three delays" model (deciding to seek care · reaching a facility · receiving care).
Apply the definition and the bundle — these are deterministic rules from the Series, not predictive models.
Enter measured cumulative blood loss and vital signs. The tool applies the 2025 reappraised definition: PPH = ≥300 mL + any abnormal sign, OR ≥500 mL.
Which of the three E-MOTIVE trigger criteria fires for this woman? Tap the scenario, then check.
16 board-style questions. One answer each. Explanations and sources revealed after you answer.
Vancouver citations for every data point used above. Primary Series papers first.