{"id":15698,"date":"2026-03-24T15:04:07","date_gmt":"2026-03-24T08:04:07","guid":{"rendered":"https:\/\/vinphaco.net\/?p=15698"},"modified":"2026-03-24T15:36:24","modified_gmt":"2026-03-24T08:36:24","slug":"who-2025-update-management-of-postpartum-hemorrhage","status":"publish","type":"post","link":"https:\/\/vinphaco.net\/ar\/who-2025-update-management-of-postpartum-hemorrhage\/","title":{"rendered":"WHO 2025 Update: Pharmacological Strategies and the MOTIVE Care Bundle in the Management of Postpartum Hemorrhage"},"content":{"rendered":"<p data-start=\"231\" data-end=\"667\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499988\/\" target=\"_blank\" rel=\"noopener\">Postpartum hemorrhage<\/a> (PPH) remains a critical obstetric emergency that can progress at an alarming rate. While previous discussions have emphasized the importance of early recognition of blood loss at a threshold of 300 mL, this article focuses on rapid response strategies through the implementation of a simultaneous intervention bundle and the optimized use of uterotonic agents according to the latest standards.<\/p>\n<p data-start=\"669\" data-end=\"878\">The most significant paradigm shift in 2025 is the transition from a sequential, stepwise approach to a rapid, concurrent intervention strategy aimed at arresting bleeding within the earliest critical minutes.<\/p>\n<hr data-start=\"880\" data-end=\"883\" \/>\n<h4 data-section-id=\"1ate8cb\" data-start=\"885\" data-end=\"950\">1. The MOTIVE Care Bundle: A Gold Standard for Rapid Response<\/h4>\n<p data-start=\"952\" data-end=\"1300\">The MOTIVE care bundle is no longer a reference framework but has been established as a standard protocol by WHO, FIGO, and ICM for immediate implementation upon diagnosis of PPH. Its core distinction lies in simultaneity: all interventions are performed concurrently by a multidisciplinary team, rather than sequentially with delays between steps.<\/p>\n<p data-start=\"1302\" data-end=\"1357\">The MOTIVE bundle consists of five parallel components:<\/p>\n<figure id=\"attachment_15699\" aria-describedby=\"caption-attachment-15699\" style=\"width: 666px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-15707\" src=\"https:\/\/vinphaco.net\/wp-content\/uploads\/2026\/03\/The-E-MOTIVE-care-bundle-intervention-640x264.webp\" alt=\"WHO MOTIVE Bundle for Postpartum Hemorrhage Management 2025\" width=\"666\" height=\"275\" srcset=\"https:\/\/vinphaco.net\/wp-content\/uploads\/2026\/03\/The-E-MOTIVE-care-bundle-intervention-640x264.webp 640w, https:\/\/vinphaco.net\/wp-content\/uploads\/2026\/03\/The-E-MOTIVE-care-bundle-intervention-768x317.webp 768w, https:\/\/vinphaco.net\/wp-content\/uploads\/2026\/03\/The-E-MOTIVE-care-bundle-intervention-320x132.webp 320w, https:\/\/vinphaco.net\/wp-content\/uploads\/2026\/03\/The-E-MOTIVE-care-bundle-intervention-800x330.webp 800w, https:\/\/vinphaco.net\/wp-content\/uploads\/2026\/03\/The-E-MOTIVE-care-bundle-intervention.webp 850w\" sizes=\"auto, (max-width: 666px) 100vw, 666px\" \/><figcaption id=\"caption-attachment-15699\" class=\"wp-caption-text\">WHO MOTIVE Bundle for Postpartum Hemorrhage Management 2025<\/figcaption><\/figure>\n<ul data-start=\"1359\" data-end=\"2423\">\n<li data-section-id=\"90p4nf\" data-start=\"1359\" data-end=\"1555\"><strong data-start=\"1361\" data-end=\"1385\">M \u2013 Uterine Massage:<\/strong><br data-start=\"1385\" data-end=\"1388\" \/>This is the first immediate mechanical intervention, aimed at stimulating uterine contractions to compress blood vessels at the placental site and reduce blood loss.<\/li>\n<li data-section-id=\"qegiug\" data-start=\"1557\" data-end=\"1694\"><strong data-start=\"1559\" data-end=\"1582\">O \u2013 Oxytocic Drugs:<\/strong><br data-start=\"1582\" data-end=\"1585\" \/>Administration of uterotonic agents to maintain sustained uterine tone and prevent recurrent uterine atony.<\/li>\n<li data-section-id=\"1x0tl9y\" data-start=\"1696\" data-end=\"1935\"><strong data-start=\"1698\" data-end=\"1728\">T \u2013 Tranexamic Acid (TXA):<\/strong><br data-start=\"1728\" data-end=\"1731\" \/>A major strategic update in 2025 is the elevation of TXA to first-line therapy rather than a last-resort option. TXA reduces mortality due to bleeding by 31% when administered within 3 hours postpartum.<\/li>\n<li data-section-id=\"nbxwt9\" data-start=\"1937\" data-end=\"2153\"><strong data-start=\"1939\" data-end=\"1967\">IV \u2013 Intravenous Fluids:<\/strong><br data-start=\"1967\" data-end=\"1970\" \/>Volume resuscitation using isotonic crystalloids (e.g., 0.9% sodium chloride or Ringer\u2019s lactate) to stabilize hemodynamics, maintain organ perfusion, and prevent hypovolemic shock.<\/li>\n<li data-section-id=\"1txrk34\" data-start=\"2155\" data-end=\"2423\"><strong data-start=\"2157\" data-end=\"2190\">E \u2013 Examination &amp; Escalation:<\/strong><br data-start=\"2190\" data-end=\"2193\" \/>Thorough assessment of the birth canal to exclude alternative causes (e.g., genital tract lacerations, retained placenta) and prompt escalation to advanced interventions such as surgery or blood transfusion if bleeding persists.<\/li>\n<\/ul>\n<p data-start=\"2425\" data-end=\"2666\">Evidence from the E-MOTIVE clinical trial involving over 300,000 women demonstrates that implementation of this bundle reduces severe PPH-related complications by up to 60%, significantly lowering rates of blood transfusion and hysterectomy.<\/p>\n<hr data-start=\"2668\" data-end=\"2671\" \/>\n<h4 data-section-id=\"1ub28qa\" data-start=\"2673\" data-end=\"2756\">2. Repositioning of Uterotonic Agents: Distinguishing Prevention from Treatment<\/h4>\n<p data-start=\"2758\" data-end=\"2912\">The <a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789240115637\" target=\"_blank\" rel=\"noopener\">2025 WHO<\/a> recommendations introduce a critical \u201crepositioning\u201d of uterotonic drugs based on updated evidence regarding safety and optimal clinical use.<\/p>\n<ul data-start=\"2914\" data-end=\"3994\">\n<li data-section-id=\"1xk4o97\" data-start=\"2914\" data-end=\"3247\"><strong data-start=\"2916\" data-end=\"2967\">Methylergometrine: Restricted to Treatment Only<\/strong><br data-start=\"2967\" data-end=\"2970\" \/>One of the most notable changes is the removal of methylergometrine (ergometrine) from routine prophylaxis due to its association with hypertension and cardiovascular risks. It is now recommended as a second-line treatment option when the uterus fails to respond to oxytocin.<\/li>\n<li data-section-id=\"j4o3pb\" data-start=\"3249\" data-end=\"3465\"><strong data-start=\"3251\" data-end=\"3317\">Oxytocin \u2013 The Gold Standard for Both Prevention and Treatment<\/strong><br data-start=\"3317\" data-end=\"3320\" \/>Oxytocin remains the first-line agent for both prophylaxis and treatment of PPH due to its rapid onset, safety profile, and cost-effectiveness.<\/li>\n<li data-section-id=\"dinqdb\" data-start=\"3467\" data-end=\"3721\"><strong data-start=\"3469\" data-end=\"3510\">Carbetocin \u2013 Preferred for Prevention<\/strong><br data-start=\"3510\" data-end=\"3513\" \/>Heat-stable carbetocin is strongly recommended for PPH prevention across all deliveries, particularly in cesarean sections or in settings where cold-chain storage for oxytocin cannot be reliably maintained.<\/li>\n<li data-section-id=\"12cabg1\" data-start=\"3723\" data-end=\"3994\"><strong data-start=\"3725\" data-end=\"3767\">Tranexamic Acid (TXA) \u2013 Treatment Only<\/strong><br data-start=\"3767\" data-end=\"3770\" \/>The WHO 2025 guidelines reaffirm that TXA is not recommended for PPH prophylaxis. However, in treatment, it must be administered immediately (1 g intravenously) as an integral component of the MOTIVE bundle upon diagnosis.<\/li>\n<\/ul>\n<hr data-start=\"3996\" data-end=\"3999\" \/>\n<h4 data-section-id=\"1079bb9\" data-start=\"4001\" data-end=\"4015\">3. Conclusion<\/h4>\n<p data-start=\"4017\" data-end=\"4513\">The WHO 2025 update on PPH management emphasizes that successful outcomes do not rely on a single drug, but rather on the rapid, simultaneous implementation of the MOTIVE care bundle combined with the appropriate use of pharmacological agents at the correct time. The repositioning of key agents such as methylergometrine and tranexamic acid enhances both the scientific rigor and safety of treatment protocols, transforming PPH from a life-threatening complication into a controllable condition.<\/p>\n<p data-start=\"4515\" data-end=\"4914\">In parallel with WHO 2025 evidence, <a href=\"https:\/\/vinphaco.net\/about-us\/\">Vinphaco<\/a> currently provides high-quality obstetric pharmaceutical options, including Oxytocin 5 IU and 10 IU, Carbetocin 100 mcg\/1 mL, Methylergometrine 0.2 mg\/1 mL, and Tranexamic Acid 500 mg\/5 mL. These products support healthcare professionals in delivering timely and effective treatment upon diagnosis, thereby improving clinical outcomes and patient health.<\/p>\n<hr data-start=\"4916\" data-end=\"4919\" \/>\n<h4 data-start=\"4921\" data-end=\"4938\"><strong data-start=\"4921\" data-end=\"4936\">References:<\/strong><\/h4>\n<ol>\n<li>WHO. <em data-start=\"4946\" data-end=\"5048\">Consolidated Guidelines for the Prevention, Diagnosis, and Treatment of Postpartum Haemorrhage (PPH)<\/em>. 2025.<\/li>\n<li>Gallos I, et al. Prognostic accuracy of clinical markers of postpartum bleeding. <em data-start=\"5141\" data-end=\"5153\">The Lancet<\/em>. 2025.<\/li>\n<li>Drug Use Guidelines in the Prevention and Treatment of Postpartum Hemorrhage \u2013 Tu Du Hospital.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Postpartum hemorrhage (PPH) remains a critical obstetric emergency that can progress at an alarming rate. While previous discussions have emphasized the importance of early recognition of blood loss at a threshold of 300 mL, this article focuses on rapid response strategies through the implementation of a simultaneous intervention bundle and the optimized use of uterotonic&#8230;<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[97],"tags":[1169,1162,1171,1170,120,1168],"class_list":["post-15698","post","type-post","status-publish","format-standard","hentry","category-medical-information","tag-carbetocin","tag-pharmaceutical-products","tag-postpartum-hemorrhage","tag-update","tag-vinphaco","tag-who-2025"],"acf":[],"_links":{"self":[{"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/posts\/15698","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/comments?post=15698"}],"version-history":[{"count":3,"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/posts\/15698\/revisions"}],"predecessor-version":[{"id":15717,"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/posts\/15698\/revisions\/15717"}],"wp:attachment":[{"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/media?parent=15698"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/categories?post=15698"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vinphaco.net\/ar\/wp-json\/wp\/v2\/tags?post=15698"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}