1. Executive summary	7
2. FIGO recommendations for the prevention and treatment of postpartum hemorrhage	8
2.1. FIGO recommendations for prevention of postpartum hemorrhage	8
2.2. FIGO recommendations for treatment of postpartum hemorrhage	8
3. Background	10
3.1. Introduction	10
3.2. Past FIGO recommendations for PPH	10
3.3. Definition of postpartum hemorrhage	10
3.4. Etiologies/risk factors	10
4. Postpartum hemorrhage bundle care	13
5. Shock index evidence in postpartum hemorrhage evaluation and management	15
5.1. Assessment of circulating blood volume in postpartum hemorrhage	15
6. Review of guidelines around the world	17
6.1. Guidelines that address the prevention of postpartum hemorrhage	17
6.2 Guidelines that address the treatment of postpartum hemorrhage	20
7. Medical prevention and treatment	27
7.1. Carbetocin versus oxytocin use in PPH: recent evidence	27
7.1.1. Clinical evidence for PPH prevention: oxytocin versus carbetocin (vaginal delivery)	27
7.1.2. Clinical evidence for PPH prevention: oxytocin versus carbetocin (cesarean delivery)	27
8. Tranexamic acid	30
8.1. Administration of TXA	30
8.2. TXA as a prophylactic measure	30
8.3. Adverse reactions to TXA	31
8.4. Contraindications	31
8.5. Implementation of treatment with TXA	31
9. Nonsurgical conservative management	32
9.1. Nonpneumatic antishock garment (NASG)	32
9.1.1. Safety	32
9.1.2. Effectiveness and advantages	32
9.1.3. Indications	33
9.1.4. Instructions for use	33
9.1.5. Monitoring and removal	33
9.1.6. Adverse effects	34
9.1.7. Contraindications	34
9.2. Uterine balloon tamponade	34
9.2.1. Available UBT devices	35
9.2.2. Tamponade effect	35
9.2.3. Free flow tamponade device	35
9.2.4. Drainage port	35
9.2.5. Correct placement	35
9.2.6. Assessment of effect	35
9.2.7. Transfer	36
9.2.8. UBT after cesarean delivery	36
9.2.9. Combining UBT with compression sutures	36
9.2.10. Other uses of UBT	36
9.3. Uterine artery embolization	37
9.3.1. Complications	38
9.3.2. Implementation of treatment	38
10. Surgical treatment	39
10.1. Uterine compression sutures for PPH	39
10.1.1. Commonly used compression sutures for managing PPH	39
10.2. Uterine artery ligation	40
10.3. Bilateral internal iliac artery ligation	41
10.4. Hysterectomy	41
11. Assessment and resuscitation	43
11.1. Damage control resuscitation in PPH	43
11.1.1. Decision for damage control surgery	43
11.1.2. Bleeding control	43
11.1.2.1. Initial laparotomy	43
11.1.2.2. Resuscitation –ICU	44
11.1.2.3. Definitive surgery	44
11.1.2.4. Definitive closure of abdominal wall and cavity	44
11.1.3. Complications	44
11.1.4. Final objectives in resuscitation	44
11.2. Resuscitation	45
11.2.1. Hypotensive resuscitation	45
11.2.2. Intravenous fluids	45
11.2.3. Targeted blood pressure	45
11.2.4. Aggressive approach and adverse outcomes	45
11.2.5. Evidence	45
11.2.6. Hemostatic resuscitation	46
11.2.7. Transfusion ratios	46
11.2.8. Fibrinogen and cryoprecipitate	46
11.2.9. Massive transfusion protocols	46
11.2.10. Adverse outcomes	47
12. Key statements	48
13. Implementation of the FIGO recommendations by health systems and national societies for the management of postpartum hemorrhage	50
Members of the FIGO Safe Motherhood and Newborn Health Committee, 2018–2021	50