Pakistani experts outline measures to prevent maternal deaths

ISLAMABAD: New consolidated childbirth guidelines co-developed by Pakistani experts recommend that every woman giving birth should immediately receive a uterotonic drug such as oxytocin to prevent excessive bleeding after delivery, a leading cause of maternal deaths in Pakistan and other low-income countries.

The guidelines also call for objective measurement of blood loss, early use of tranexamic acid, and emergency preparedness at every maternity facility to prevent postpartum haemorrhage, which kills around 70,000 women worldwide every year.

According to the World Health Organization, postpartum haemorrhage remains the single largest cause of maternal deaths globally, accounting for nearly one fifth of all fatalities during childbirth. In Pakistan, where the maternal mortality ratio is about 186 per 100,000 live births, roughly one in every four mothers dies from complications linked to excessive bleeding after delivery. Experts say consistent application of these new recommendations could prevent hundreds of such deaths each year.

The Consolidated Guidelines for the Prevention, Diagnosis and Treatment of Postpartum Haemorrhage were jointly developed by the World Health Organization, the International Federation of Gynaecology and Obstetrics, and the International Confederation of Midwives. The panel of 23 international experts included Pakistan’s Dr Sadiah Ahsan Pal and Prof. Syeda Batool Mazhar, who helped shape and review the recommendations alongside Dr Ferdousi Begum from Bangladesh, Dr Hadil Ali Masri from Palestine, and Indian specialists Dr Suneeta Mittal and Dr Deepali Upadhyaya.

Among the most important measures, the guidelines recommend that all women giving birth should be given a uterotonic such as oxytocin (10 IU) immediately after delivery to prevent haemorrhage. In facilities where cold storage for oxytocin is unavailable, heat-stable carbetocin (100 µg) or oral misoprostol (400–600 µg) should be used instead. The use of older combinations such as ergometrine or prostaglandin injections is discouraged because of safety concerns.

The WHO also urges hospitals and birthing centres to move away from rough visual estimates of bleeding and instead use calibrated drapes or other objective tools to measure blood loss. The new definition of postpartum haemorrhage identifies it as 300mls or more of blood loss with low blood pressure or rapid pulse, or 500mls or more within 24 hours of delivery. If bleeding starts, the guidelines recommend rapid administration of intravenous oxytocin, uterine massage, and early use of tranexamic acid within three hours of birth to save the mother’s life. When bleeding does not stop, health workers should use a uterine balloon tamponade as a temporary measure before surgery and ensure prompt referral to a higher-level facility with blood transfusion support.

For low-resource settings like Pakistan, the WHO has advised adopting formal hospital protocols, regular emergency simulation drills, and ensuring continuous supply of essential drugs and fluids. Health facilities are urged to record how many women receive a uterotonic within one minute of delivery and how quickly the full treatment bundle is completed after diagnosis, to improve accountability and performance.

The guideline also stresses prevention during pregnancy. It recommends daily iron and folic acid supplementation and intravenous iron therapy for women with severe anaemia. With more than 40 percent of Pakistani women suffering from anaemia, WHO experts say this simple step can reduce both maternal and neonatal complications. For Pakistan, where many rural maternity homes and basic health units lack reliable electricity and proper cold-chain facilities, the use of heat-stable carbetocin and oral misoprostol could be transformative. These options allow healthcare workers to prevent fatal bleeding even outside major hospitals.

Health officials say the new guidelines can help Pakistan move closer to the global target of reducing maternal deaths to fewer than 70 per 100,000 live births by 2030 if they are adopted nationwide. “These are practical, science-backed steps that can be implemented immediately across all levels of the healthcare system,” said a senior federal health official. “No woman should die while giving life.”

The new WHO document, developed with strong South Asian and Muslim representation, offers countries like Pakistan a clear roadmap to end preventable maternal deaths through evidence-based care, better training, and stronger health systems.