Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Uterine massage is recommended for the treatment of postpartum haemorrhage
Recommended
Notes and Remarks
- Uterine massage as a therapeutic measure is defined as the rubbing of the uterus achieved through the manual massaging of the abdomen. This is typically sustained until the bleeding stops or the uterus contracts. The GDG emphasized that uterine massage should be started once PPH has been diagnosed, as part of the first-response treatment bundle, which includes administration of uterotonics, tranexamic acid, intravenous fluids and examination of the genital tract and escalation of care.
- The initial rubbing of the uterus and expression of blood clots are not regarded as therapeutic uterine massage.
- Uterine massage may be repeated or continued intermittently, based on the clinical response, particularly if bleeding persists despite administration of uterotonics.
- The GDG noted that the application of this intervention requires training and that maternal discomfort and complications associated with these procedures have been reported.
- When formulating this recommendation, the low cost and safety of uterine massage were considered.
- This recommendation is specific to the treatment of PPH and not intended for routine or sustained use as a preventive measure in women who have already received prophylactic uterotonics (see Recommendation 20 on uterine massage for PPH prevention).