<scp>FIGO</scp> recommendations on objective measurement of blood loss after birth for early detection of postpartum hemorrhage

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, particularly in resource-constrained and remote settings. The cornerstone of reducing PPH-related morbidity and mortality lies in its early recognition, timely treatment, and adherence to evidence-based protocols, all of which are heavily dependent on an accurate assessment of postpartum blood loss. Visual estimation, unfortunately, is still widely used, highly inaccurate, and often leads to underdiagnosis, resulting in a delayed or sometimes absent response to PPH. Objective quantification of blood loss, although not perfectly precise, provides a far more reliable estimate and is critical to triggering timely and effective interventions. This approach requires coordinated teamwork, leadership, institutional commitment, and a shift in clinical culture from subjective to standardized measurement practices. Scientific evidence strongly supports the integration of objective quantification into routine obstetric care. The use of calibrated drapes, cumulative measurement, and the combination of quantification with early warning systems have all proven to be effective in reducing PPH-related complications and deaths. Practical barriers are faced in implementing objective measurement strategies at the facility and institutional level, including availability, supply costs, environmental concerns, national and institutional advocacy, policy change, leadership, appropriate training, and, more importantly, resistance to change. Low-cost, reusable, and locally made devices can offer promising solutions for scaling up this intervention in resource-limited environments. Sustained success will depend on engagement with health departments of the governments for framing policies, guidelines for implementation, procurement and regular supplies, inter-institutional collaboration, and ongoing and refresher training for in-service healthcare providers. In the longer term, it requires inclusion into the medical curriculum, local leadership, champions, behavioral interventions, recognition and rewards to individuals, and teams who promote long-term adherence to best practice. Ultimately, although technical knowledge on PPH management is now well established, the real challenge lies in its consistent and context-appropriate identification and application. This article discusses the different definitions of PPH. It highlights the importance of objective quantification of blood loss during and after childbirth and the various available methods for blood loss measurement and explores their implementation across different clinical settings.